Clinical snapshots. Results from the PCDS survey series: NICE type 2 diabetes guidance

Over a 2-week period in March 2016, approximately 200 healthcare professionals completed the survey on the updated NICE type 2 diabetes guidelines published in November 2015. More than 85% were aware of the new guidelines. PCDS members were asked what part of the new NICE guidance was most different from their current clinical practice – 35% answered the new guidance on pioglitazone, closely followed by changes to the recommendations on individualisation (31%), glycaemic targets (30%) and sodium–glucose cotransporter 2 inhibitors (26%).

More than half of the PCDS members who responded and who are able to intensify treatment, or recommend intensification, tended to intensify to two agents when HbA_1c was 58 mmol/mol (7.5%), which is the NICE recommendation. Respondents were also given the opportunity to expand their answer; 16% wrote that they took an individualised-approach to intensification taking into account age and other comorbidities. This is also in agreement with updated recommendations on individualisation of glycaemic control.

The NICE type 2 diabetes algorithm states that glucagon-like peptide (GLP)-1 receptor agonists should be considered if triple therapy (which may include insulin) fails in those on metformin, and BMI and other criteria are met (i.e. BMI is >35 kg/m² and there are psychological or medical issues associated with obesity, or BMI is <35 kg/m² and insulin therapy would have significant occupational implications, or weight loss would benefit other obesity-related comorbidities). The results of the survey show that 35% of respondents would use GLP-1 receptor agonists when all oral agents had failed (Figure 1a); however, a quarter would initiate, or refer for initiation of, a GLP-1 receptor agonist at first intensification and 41% at second intensification. Figure 1b shows respondents felt the updated treatment algorithm was the most useful part of the new guidance.