Hyperlipidaemia guidelines not being adequately followed

Guidelines for the management of hyperlipidaemia/hypercholesterolaemia in patients with cardiovascular disease or diabetes are not adequately followed according physicians. In a survey of 101 GPs and 76 cardiologists, 66 % were found to hold this view.

Time required to titrate a statin, cost constraints, restrictions imposed for reimbursment or by local guidelines and risks associated with high-dose statins were all listed as reasons why guidelines are not being followed.

GPs are more likely than cardiologists to follow the National Institute for Health and Clincial Excellence (28 % versus 20 %), British Hypertension Society (11 % vs 9 %) and local primary care trust (12 % vs 0 %) guidelines. Cardiologists were more likely to follow the Joint British Societies’ guidelines (34 % vs 14 %) or the European Society of Cardiologists (20 % vs 0 %). Around one in four physicians were not able to name any guidelines relating to optimal management of hyperlididaemia/hypercholesterolaemia in this patient group.

The survey was commissioned by Merck Sharp and Dohme and Schering-Plough.

Clopidogrel can now be used with aspirin for people with STEMI
Clopidogrel (Plavix; Bristol-Myers Squibb and Sanofi-Synthelabo, Uxbridge and Guildford, respectively) has now been licensed for use in combination with aspirin for the prevention of further atherothrombotic events in patients with ST-segment elevation myocardial infaction (STEMI), who have been medically treated and are eligible for thrombolytic therapy. The licence states that treatment for these people should continue for at least 4 weeks.

The licence is based on the results of the CLopidogrel as an Adjunctive ReperfusIon TherapY (CLARITY) and ClOpidogrel and Metoprolol in Myocardial Infarction Trial (COMMIT).

Insulin aspart approved for pregnant women with diabetes
Insulin aspart (NovoRapid; Novo Nordisk, Crawley) is now licensed for use in pregnancy. The approval followed a randomised, parallel-group, open-label trial of 322 pregnant women with type 1 diabetes. The results show that insulin aspart significantly improves postprandial glycaemic control (first trimester; P<0.01, second trimester; P<0.05) compared with human insulin.

Neonatal hypoglycaemia requiring treatment occurred in 33.6 % of neonates in the insulin aspart group and 39.7 % in the human insulin group.

First pump and continuous monitoring system launched
The first integrated insulin pump and continuous glucose monitoring system has been launched by Medtronic Diabetes (Watford).

The MiniMed Paradigm REAL-Time device displays current glucose levels and graphs showing trends. The device also shows directional arrows allowing patients to understand how their glucose levels are affected by various daily activities, such as diet, exercise and medication. It is hoped that patients will gain further insight into their insulin requirements when using the device.

Pioglitazone licensed for use in triple combination therapy
Pioglitazone (Actos; Takeda, High Wycombe) has been approved for use in triple combination therapy with metformin and a sulphonylurea in patients with type 2 diabetes who have insufficient glycaemic control.

The new licence has been granted on the basis of data from the PROspective pioglitAzone Clinical Trial In macroVascular Events study (PROactive) study. This study showed that adding pioglitazone to dual therapy of a sulphonylurea and metformin gives patients better glycaemic control. In addition, some patients were subsequently able to drop either metformin or a sulphoylurea from their drug regimen or avoid the need for insulin therapy.

Professor Anthony Barnett, Head of Diabetes Services at the Heart of England NHS Foundation Trust, commented that, ‘This is really good news for people with diabetes — it gives support to what many diabetes specialists have known for many years, i.e., triple oral therapy including a glitazone can provide significant improvement in diabetes control in those not achieving target on dual therapy.’

New pen available for insulin glargine and insulin glulisine
A new pen for insulin glargine (Lantus; Sanofi-Aventis, Guildford) and insulin glulisine (Apidra; Sanofi-Aventis) has been launched. The OptiClik device provides insulin in single unit increments, upto a maximum of 80 units. The device is intended to make titrating insulin to the desired dose easier.