Topic:

In May 2009, NICE published recommendations on the use of newer agents for the control of blood glucose in type 2 diabetes. This guideline provides a partial update for NICE Clinical Guideline 66 on the management of type 2 diabetes that was published last year. These newer agents include the dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones (TZDs), the glucagon-like peptide-1 (GLP-1) mimetic exenatide and the long-acting insulin analogues (insulin detemir and insulin glargine).

Management of type 2 diabetes continues to be very challenging. Adherence with therapy is poor, due in part to the number of medications and the high frequency they need to be taken each day. PillTime is a new system which makes managing medicines easier and is ideal for those on multiple medicines and active lifestyles.

A new study led by the University of Leicester suggests that one in three people who suffer from high blood pressure are failing to take medication as prescribed by their healthcare professionals. Non-adherence to antihypertensive treatment is a critical contributor to suboptimal blood pressure control.

Alirocumab (Praluent®) and evolocumab (Repatha®) have received final approval from NICE for the treatment of adults with primary hypercholesterolaemia or mixed dyslipidaemia to help reduce the risk of cardiovascular disease.

Alirocumab (Praluent) and evolocumab (Repatha) have been recommended by NICE for the treatment of adults with primary hypercholesterolaemia or mixed dyslipidaemia to help reduce the risk of cardiovascular disease.

Canagliflozin (Invokana™), dapagliflozin (Forxiga™) and empagliflozin (Jardiance™) have received final NICE approval in type 2 diabetes and are now available to patients with type 2 diabetes who cannot tolerate metformin, sulfonylurea or pioglitazone therapy and are not being controlled with diet and exercise.

A new Cochrane Review highlights the value of nurse-led titration of ACE inhibitors, beta-blockers and angiotensin II receptor blockers in patients with chronic heart failure. All-cause mortality and hospitalisations were lower in the nurse-led titration group compared with the usual care of titration by GPs.

Primary care nurses play a central role in the management of type 2 diabetes in the community. This includes helping patients to use their drug treatment correctly. Although many patients with type 2 diabetes initially respond well to weight loss and exercise, most require oral hypoglycaemics and half of all patients eventually require insulin to control their glucose levels in order to prevent the devastating long-term complications of inadequately controlled diabetes. Linda Goldie gives an up-to-date review of the newer insulins – including the insulin analogues, insulin lispro, insulin aspart and insulin glargine – that have been introduced.

There is good evidence that tight glycaemic control significantly improves outcomes in patients with type 2 diabetes. All practice nurses will be looking to achieve the new General Medical Services contract (GMS2) targets for HbA1c reduction in diabetes (see box). Practices will be developing prescribing strategies to achieve this reduction, in accordance with good clinical practice. Metformin offers an important first-line therapy for type 2 diabetes. The introduction of a new, sustained-release formulation – Glucophage SR – should improve patient compliance with metformin and so improve glycaemic control.