Guidelines on the management of type 2 diabetes, released by the National Institute for Health and Care Excellence (NICE), anticipates a “resource impact” and potential increased prescription costs.
The report says that clinical commissioning groups (CCGs) should monitor type 2 diabetes prescribing practices after the guidance has been implemented, the guidance stated, as a shift in the drugs used could lead to an increase from an £841 annual spend on a type 2 diabetes patient to a spend of £4,312 each year.
This is as the previous guideline, from 2009, recommended sulfonylurea as the second drug choice after metformin (either as the initial drug treatment when metformin is contraindicated or not tolerated, or in addition to metformin), however the new guideline recommends more expensive DPP-4 inhibitors.
Treatment with sulfonylureas is estimated to have an average cost of £841 per patient per year compared with an estimated average cost of £4,312 for DPP-4 inhibitors.
The guideline also recommends an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences, comorbidities, risks from polypharmacy, and their ability to benefit from long term interventions because of reduced life expectancy.
Moreover, it also gives GPs more prescribing options, as they can now choose a gliptin, pioglitazone, sulfonylurea or a gliflozin, as an additional treatment to metformin if patients are struggling to get their blood glucose levels under control. The guidance also provides clinicians with an algorithm for blood glucose lowering therapy in adults with type 2 diabetes, and recommends that they “relax” the target HbA1c levels.
GPs should: “Consider relaxing the target HbA1c level on case by case basis, with particular consideration for people who are older or frail, for adults with type 2 diabetes: who are unlikely to achieve longer-term risk-reduction benefits,” including people with a reduced life expectancy, who are at risk of falling, or people with significant comorbidities.”
Dr Ian Lewin, NICE guideline developer and retired consultant endocrinologist, commented: “The guideline highlights that putting people with type 2 diabetes at the centre of their care package is essential. For example the guideline recommends that adults with type 2 diabetes should be involved in decisions about their individual HbA1c target – the average amount of glucose in their blood over two to three months.
“Health professionals are also advised to individualise recommendations for carbohydrate intake and alcohol intake, and meal patterns. All of these steps should result in improved outcomes for adults with type 2 diabetes – reduced complications and better health,” he added.
See the full guidance here