More Talk, More Action Required In Treatment Of Type 2 Diabetes

Main Category: Diabetes
Article Date: 14 Mar 2008 - 2:00 PDT

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The National Prescribing Service Limited (NPS) is advising health professionals to be more aggressive in their management of patients with type 2 diabetes.

The latest education program for NPS - 'Early use of insulin and oral antidiabetic drugs' - focuses on appropriate drug therapies, earlier introduction of insulin, lifestyle interventions and the close relationship between type 2 diabetes and cardiovascular events.

NPS spokeswoman Judith Mackson said a plethora of recent information surrounding the risks of thiazolidinedione (glitazone) use, the need for more pro-active medical management of diabetes and patient resistance to introducing insulin had created concern and uncertainty among some health professionals about how to escalate treatment once control is no longer achieved with one or two oral agents.

"When dietary changes, adequate regular exercise and oral agents are failing to control blood glucose levels, it can be challenging for health professionals to know which drug therapy will be suitable for their patients," Ms Mackson said. NPS still recommends metformin as first-line therapy in most cases - either alone or in combination with other oral drugs.

"When oral therapy is no longer working effectively, early introduction of insulin is optimal for reducing diabetes-related micro-vascular complications and maximising overall health. However, convincing patients to start administering insulin is another matter entirely," Ms Mackson added. "A major thrust of this NPS program is advising GPs, pharmacists, nurses and other health professionals on how to initiate insulin simply and safely, as well as specific counselling points to overcome common patient barriers. Our recommendation is to introduce night-time basal insulin with existing combination drug therapy - they should not be mutually exclusive."

The program also examines current evidence and controversies around the benefits and harms of glitazones, particularly as they relate to patients with existing heart failure or ischaemic heart disease and those at high risk.

NPS has focused this edition of its bi-monthly bulletin, NPS News (no 56) on 'Managing hyperglycaemia in type 2 diabetes'. NPS Facilitators, based in divisions of general practice around Australia, will conduct educational visits and group discussions with a range of health professional groups over coming months. Additionally, GPs, pharmacists, nurses and diabetes educators can participate in a clinical audit and case study, which will contribute to their continuing professional development (CPD) points.

To obtain a copy of NPS News or for more information on the NPS education program, 'Early use of insulin and oral antidiabetic drugs', visit the website http://www.nps.org.au.

National Prescribing Service Limited