October
2007 NEWSLETTER
INSULIN
ANALOGUES
HOW MUCH MORE EVIDENCE DO WE NEED?
Let’s take a look at the evidence now in the public domain:
·
Human insulins are not superior to animal insulin - Cochrane
Review, 2002
·
Rapid-acting insulin analogues have only minor
benefit for the majority of patients - Cochrane Review, 2004
·
Rapid-acting insulin analogues are not superior to human insulin for the
treatment of Type 2 - the Institute for Quality and Cost Effectiveness in the Health
Care Sector [IQWiG], July 2006
· Rapid-acting insulin
analogues are not superior to human insulin for the
treatment of adults with Type 1 diabetes. The benefits for children and
adolescents are unclear for lack of data - IQWiG, June 2007
·
Long-acting analogue insulins can be used as
an option for people with Type 1 diabetes but not for those with type 2
diabetes, except under special circumstances - NICE guidance, 2002.
·
Long-acting insulin analogues are not listed
for treatment of Type 1 and Type 2 diabetes because they are not superior to
NPH human insulin - Canadian Expert Drug Advisory Committee [CEDAC], June and
Sept 2005.
·
Long-acting insulin analogues have only minor
benefit, if at all, for the treatment of Type 2 diabetes - Cochrane Review, April
2007.
It is reasonable to say that there is little evidence that insulin
analogues are superior to their predecessors but is this lack of superiority
important?
It may not seem so to some but this is not the case. Already 40% of
people with diabetes have had their insulin changed unnecessarily, according to
the evidence above and the newly diagnosed are automatically being treated with
analogues, all at a significantly higher cost. So on what basis are analogues
being prescribed? Assumptions? Sales hype from the insulin manufacturers to
hook people on to the only insulins still in patent which can therefore be sold
at a higher price and greater profit?
So insulin analogues have no benefits over previous insulins but what
about their risks? Their long-term safety has not been established, they have
always had the potential for carcinogenic effects and there is growing evidence
of their mitogenic effects [cell multiplication which could lead to tumours].
So now there are real grounds to question whether these risks, high or low, are
worth taking for analogue insulins that are not superior to their predecessors
and more expensive. Compared to health risks, cost is less important but
Professor Edwin Gale questions whether people with diabetes are getting the
best deal when the choice is between treating 150-200 patients with long-acting
analogues instead of human insulin or employing a full time specialist nurse
educator at the same cost. [Diabetologia (20070 50:1783-1790]
While IDDT has been asking these questions since the introduction of
human insulin, they must be answered and sooner rather than later. In
discontinuing animal insulin and announcing the intention to discontinue human
insulins, manufacturers are foisting insulin analogues upon us. Sadly in
diabetes the choice of treatment has never truly rested with patients but soon
it will not be our doctors that are making our treatment decisions but drug
companies. This is unacceptable, harmful and sets a dangerous precedent for
healthcare.
IDDT
GOES TO
Progress
Report
Supplies of
Wockhardt Hypurin Pork insulins
IDDT
has followed up reports of difficulties obtaining Hypurin Porcine insulins and
on each occasion and the majority of the times, Wockhardt has the insulin in
stock and the problems are with misinformation from the pharmacy wholesaler.
Misinformation
about future availability of pork insulin
Many
people are being told by doctors, nurses and pharmacists that ALL animal
insulins are no longer available – not so, it is only Novo Nordisk that have
chosen to do this. Wockhardt has sent information to GPs, hospital diabetes
clinics and PCTs but the misinformation continues! On further enquiry, part of
the problem is that several GP and pharmacy databases are incorrect. We have pursued this with the Dept of Health
and Wockhardt.
Meeting at the Dept
of Health,
This
was chaired by Dr Sue Roberts, National Clinical Director for Diabetes and
attended by the Chief Executives of Novo Nordisk and Wockhardt and a representative
of Diabetes
·
Wockhardt confirmed their intention to continue to
provide animal insulins. They have bought in several years-worth of the raw
materials for which IDDT expressed gratitude!
·
The
misinformation problems were aired and the Dept of Health is now following up
the issues of misinformation on professional databases with vigour.
NICE assessing all
insulins
·
Early Day Motion
535 tabled by Sandra Gidley MP – this called for NICE to assess all the
insulins to provide the necessary information for patients and doctors to make
informed choices. 107 MPs signed the EDM and many others supported it by
raising the issues at Ministerial level.
·
The All Party
Parliamentary Group agreed
to take forward a briefing paper prepared by IDDT and the then Minister of
Health, Andy Burnham agreed to ask NICE to carry out an assessment of all
insulins. When nothing happened another Health Minister,
IDDT Meeting [
Jenny
explained IDDT’s philosophy that people with diabetes should have an informed
choice of treatment, be involved in decision-making about their own care. The
lack of choice of animal insulin, people not being listened to and even being
denied this choice, goes against these principles. Also that our request for
NICE to assess all insulins is part of this philosophy to ensure that informed
choice is available, including the risks of new analogue insulins and that
treatment is cost effective eg if 150 people were prescribed an equally
effective but cheaper human or animal insulin, another nurse could be employed
to help with education and provide better care.
Dr
Roberts was very open with what she hopes to achieve – a better outcomes
equation, organised proactive services in partnership with engaged empowered
patients to achieve better outcomes for people with diabetes. If achieved, very
similar to IDDT’s philosophy and one that will result in people having the
choice of animal insulins! She is discussing diabetes-related topics with NICE
and would like to meet regularly with IDDT to discuss progress and any concerns
we have. A meeting is to be arranged in November/December this year.
Let’s mark our
success!
·
We have an open ended commitment from
Wockhardt that they will continue to produce animal insulins.
·
We are now in direct and regular communication
with Dr Sue Roberts who understands and listens to the needs of people with
diabetes and even IDDT!
None
of this would have been possible without our members, so many thanks for your
enthusiastic support, determination and for writing numerous letters to MPs. I
would also like to thank the many MPs who have supported us and especially
members of the All Party Parliamentary Group for Diabetes, its Chairman Adrian
Sanders MP and Earl Howe, Conservative Spokesman for Health in the House of
Lords.
APOLOGIES FOR THE MISUNDERSTANDING!
In
IDDT’s July Newsletter there was a short piece ‘While on the subject of holidays’ in which one of our members was
concerned that the security measures at airports may prevent his wife from
obtaining the Lucozade she always takes to treat her hypos. My response was
that she could obtain a ‘full-blown’ Coke, any other sugary drink or a
chocolate bar. I got a couple of comments about this advice, especially the
chocolate because of its fat content! I know this is not standard advice for
treating a hypo but I was trying to point out [1] that in emergency, anything
sweet will do and [2] hypos don’t always have to be treated with the same
thing. Most people develop their own ways of dealing with hypos but in
emergency, it may be a case of whatever is available! Sorry for the
misunderstanding.
MORE ABOUT INSULIN ANALOGUES
Long-acting
insulin analogues have mitogenic and antiapoptotic activities
Before
reading further we ordinary mortals need some explanation of the terms.
·
Apoptosis
is the normal self-termination of a cell’s life to become replaced by another
one, so antiapoptosis is the opposite.
·
Mitogenicity is the promotion of division and
proliferation of any cell, including malignant and non-malignant tumour cells.
·
IGF-1 [insulin-like growth factor] is a hormone
with a range of effects - promotion of cell survival, cell proliferation,
inhibition of apoptosis, stimulation of metabolism.
The title of this research [ref1] sounds
complicated, so I’ll do my best to explain!
It has been known since their introduction, that
insulin analogues have similarities to insulin-like growth factor [IGF-1] so
might function differently from normal insulin and could cause cell
multiplication [mitogenicity] – hence their potential to cause tumours.
This research tested whether the two long-acting
analogues, Lantus [glargine] and Levemir [determir], show IGF-1 like activities
including enhanced mitogenic and antiaopoptotic effects.
The results: both Lantus and Levemir show potent mitogenic and
antiapoptotic activities which are significantly greater than those of human
insulin and seem to resemble IGF-1 action.
The researchers comment: this
supplements the work by Eckhardt et al which found that all insulin analogues
tested were more mitogenic than insulin and this mitogenic effect was greater
in cells from patients with a high IGF-1 receptor system expression so putting
such patients at greater risk than those with a low IGF-1 receptor system
expression.
Note: this research is continuing and is being funded by
IDDT as part of the policy to address uncertainties in insulin treatment.
Ref
1 Doron Weinstein, Zvi Laron, Haim Werner. Long-acting insulin analogues have
mitogenic and antiapoptotic activities. US Endocrine Society Meeting,
Ref 2 Kristian Eckardt, Claudia May, Marlis Koenen,
Juergen Eckel. Enhanced Mitogenic Potency of Insulin Analogs in Human
Fibroplasts and Smooth Muscle Cells is mediated by IGF-l Receptor Signaling
Diabetes, ADA Diabetes Care, June 2006 Vol 55 Suppl 1 463-P
New Review - Rapid-acting analogues are not superior to ‘human’ insulin for Type 1 diabetes
Yet again we are reliant on
The insulins investigated were, Humalog
[lispro], NovoRapid [aspart] and Apidra [glulisine].
What did the review find?
·
Adults -
there is currently no evidence available to demonstrate a superiority of rapid-acting
insulin analogues in the treatment of adults with Type 1 diabetes. The value of
the evidence and design of studies so far are inadequate and do not allow
conclusions regarding most important patient goals, such as the reduction in
long-term complications or overall mortality.
·
Children and adolescents – due to lack
of data, the benefit of rapid-acting insulin analogues in children and
adolescents is unclear [an uncertainty!]. Novo Nordisk has carried out
long-term comparative studies in this group of patients but they are
withholding some of the results.
·
Pump therapy – no long-term studies were available therefore it
remains unclear whether adults would benefit and what advantage patients would
have by using analogues with insulin pumps [an uncertainty!]. The same applies
to children and adolescents as only fully published short-term studies are
available. Novo Nordisk sponsored 2 long-term studies in children and
adolescents but to date, both studies have only been partially published and
unlike Sanofi-Aventis and Lilly, Novo Nordisk were not prepared to provide the
information needed for the review.
·
Quality of life, not a fair comparison – in
some studies patients treated with insulin analogues assessed their quality of
life as higher and they were more satisfied with treatment than those using
human insulin. IQWiG did not evaluate this finding as evidence of an additional
benefit, because it was not based on a fair comparison – patients in the human
insulin group were asked to adhere to a fixed injection-meal regimes but the
analogue group were not. [As we know, it is quite possible to use a flexible
regime with all types of insulin.] So it is unclear whether the patient
satisfaction was due to the insulin or to the more flexible regime prescribed
by the physicians.
What conclusions can be drawn from this?
Basically it is simple, there is no evidence that
rapid-acting insulins are any better than human insulins for adults with type 1
diabetes. It is unclear whether they are of any benefit to children and
adolescents. It is also unclear whether they are of benefit any groups of pump
users. They are, of course, significantly more expensive to the NHS! So once
more, this review raises big questions:
·
Why is the Dept of Health so unwilling to follow
·
Why are Primary Care Trusts that are so obviously short of funds,
spending unnecessary amounts on insulin analogues that have no proven benefits
over less expensive human and animal insulins?
·
Why are adults and children with diabetes being changed to insulin
analogues when they have no proven benefit?
·
Could all this be anything to do with heavy marketing of insulin
analogues because they are the only insulins in patent, therefore more
expensive and more profitable?
And by the way, a touch of curiosity: why was Novo
Nordisk unwilling to provide the necessary information to IQWiG?
Ref
1 Rapid-acting insulin analogues versus human insulin
in type 1 diabetes, the Institute for Quality and Cost Effectiveness in the
Health Care Sector [IQWiG],
TAKING MORE AND
MORE MEDICATIONS
IDDT is frequently contacted by people expressing concerns
that they are being advised to take more and more medications. Some are
concerned that all drugs can cause side effects, while others simply do not
want to take more drugs than absolutely necessary, especially if the evidence
of benefit has not been shown. Here is an example…………..
ACE
inhibitors to protect the kidneys
ACE Inhibitors are normally used to treat raised blood
pressure [hypertension] but increasingly they are being prescribed to people
with diabetes to protect their kidneys, even if they have normal blood
pressure. It has been shown that both ACE inhibitors and
angiotensin receptor-blockers (ARBs) are effective treatments for people with
hypertension, early diabetic nephropathy, or both [ref 1]. But does
this mean that all people with diabetes should be put on one of these drugs?
According
to Dr B Hirsh [ref 1], most people put on ACE inhibitors for renal protection
do OK. However, the evidence for using ACE inhibitors for this reason was
from a study of mostly people with Type 2 diabetes over the age of 55
[MICRO-HOPE trial published in 2000]. This showed that use of the ACE inhibitor, ramipril,
significantly reduced the combined outcome of myocardial infarction,
stroke, or cardiovascular death by 25%. But do the results of this
study apply to younger people with Type 1 diabetes where the drug is
being used to protect the kidneys?
There
are no randomised controlled trials investigating ACE inhibitors for
the prevention of diabetic renal disease in people with normal blood pressure
and relatively good blood sugar control. Dr Hirsh also says that he is unaware
of any recommendations by any diabetes or kidney society for this
use. So although ACE inhibitors are prescribed frequently for kidney protection
to people without raised blood pressure, this is based on assumptions of
benefit not evidence of benefit – yet another uncertainty in the treatment of
people with diabetes.
Dr Hirsh makes 3
key points:
Note:
these statements also apply to the widespread recommendations that people with
diabetes over the age of 40 should take statins and aspirin – not everyone can
tolerate them.
Example: one of our
members with blood pressure the low side of normal but a small amount of
protein in her urine [microalbuminuria] was prescribed ACE inhibitors to
protect her kidneys but they lowered her blood pressure so that she fainted and
frequently felt lighted-headed. She was unsafe to drive, not because of
hypoglycaemia, but from the use of ACE inhibitors to protect her kidneys!
Recommendations: ‘Ask about
Medicines’ supported by the Dept of Health recommends people to always ask
questions about any new medications, why they are necessary, what are the side
effects and what evidence there is that they are safe and effective.
Ref 1
SOURCING INFORMATION
Patient information
leaflets - available to people with visual impairment
Patient
Information Leaflets [PILs] are the leaflets found inside packs of medicines.
For those with internet access, PILs are available for all
A
new service is available for people who are blind or visually impaired - called
X-PIL. The X-PIL website www.medicines.org.uk/XPIL.aspx
provides a number of electronic formats:
·
the
original package insert
·
in
large font [18-22 point]
·
in
a version that can be used by a screen reader
Over
the coming months over 2,500 PILs will be available on the X-PIL web site and
by the end of 2007 PILs will also be available in audio MP3 format. You can
also listen to a PIL by telephoning the Royal National Institute of the Blind
[RNIB] Medicines Information Line (tel 0800 198 5000). You can also request
PILs in a number of different formats - large/clear print, Braille or on audio
CD.
Many
of us use the internet as a source of information, sometimes as our main
source. Searching for health information is no exception to this but we do have
to be aware that there are some not very reliable websites. A
In
questionnaires and interviews, the study investigated 800 recently
diagnosed cancer patients' and 200 carers'
use of, and attitudes to, the internet as a source of information compared with
other sources. The average age of patients was 63 and of carers 43.
·
4.8%
of patients but 48% of carers accessed the internet directly for cancer
information.
·
Helplines
had a low use [2.9% of patients and 19.3% of carers] which the authors describe
as not cost effective.
·
Carers
were more likely to seek information for themselves, possibly as a way of
coping, but patients were more likely to use information chosen by someone else
and wanted the hospital doctor to provide internet sites. There was a high
usage of sites recommended by doctors.
·
Use
of internet information was low in ethnic minorities.
·
High
levels of satisfaction were reported for internet information rating it higher
than booklets or leaflets.
The
authors concluded that the internet is an effective source of information for
those who use it.
Ref
1: 'A Study of information seeking by cancer patients and their carers,'
Clinical Oncology, vol. 19, June 2007
HYPERTENSION
Up to 65% of people with diabetes, both Type 1 and
Type 2, have hypertension – raised blood pressure. It is caused by
atherosclerosis, a thickening of the blood vessel walls narrowing the blood
vessels so that blood flow is restricted. Long-term high blood pressure
increases the risks of other diabetic complications such as stroke, coronary
artery disease, retinopathy and nephropathy [kidney damage].
Blood pressure measurements
The numbers that are given as your
blood pressure results eg 130 over 80
are systolic and diastolic pressure readings. The systolic reading, the
top figure, is your blood pressure as your heart beats and the diastolic is the
pressure between beats. With hypertension, both systolic and diastolic readings
may be high, or the systolic alone may be high but both types can lead to
serious complications if not treated.
Presently normal blood pressure is
defined as 120/80 mmHg for people without diabetes and 130/80 mmHg for those
with diabetes and/or chronic kidney disease but these definitions can vary in
different countries.
Symptoms
Usually there are no symptoms with mild
or moderately high blood pressure so it is important to have your blood
pressure checked regularly. Many people now use home blood pressure testing
kits but it is advisable to talk to your doctor about this. If blood pressure
is extremely high the following symptoms can occur:
Treatment
Medications that may be prescribed to
reduce blood pressure include diuretics [often called water tablets],
angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers,
beta-blockers, and calcium channel blockers. It is also often recommended that
adults with diabetes take aspirin daily.
Note: recent research
[ref1] has recommended that doctors stop routinely
using beta-blockers to control high blood pressure as other hypertension pills
work better and cause fewer side effects eg fatigue and sexual dysfunction. For
many years beta-blockers and diuretics were the standard treatment for high
blood pressure but evidence is now suggesting that diuretics and newer
blood-pressure medications are superior. Beta blockers work by blocking the
effect of adrenaline on the heart which slows down the heart so that it does
not have to work as hard, so the researchers emphasise that there is strong
evidence to support the use of beta-blockers in people who have had a heart
attack or those with progressive heart failure.
Prevention
Ref 1 Journal of the
WINTER'S COMING AND SO ARE COLDS
Flu’ and pneumonia
jabs.
Don’t
forget that people with diabetes are seen as priorities for both the flu’ jab
and vaccination against pneumonia – both are free.
The common cold
Rhinoviruses
are responsible for about half of all common colds in children and adults.
School children usually catch between 7 and 10 colds a year, and adults
Echinacea 'can
prevent a cold'
Taking
the herbal remedy echinacea can more than halve the risk of catching a common
cold, according to
Echinacea
is a collection of nine related plant species indigenous to
The
researchers found that more than 800 products containing echinacea were
available, and that differing parts of the plant, flower, stem and root, were
used in different products. They said more work was needed to check the safety
of these different formulations.
Professor
Ron Cutler, of the
People
with Type 1 diabetes have an impaired immune system, so it may be worth
thinking about taking echinacea but as with all herbal remedies, you should
discuss this with your doctor.
COULD
YOU HELP WITH RESEARCH?
·
Do you have Type 1 diabetes? Are you aged 21 - 36 and
were diagnosed between the ages of 12 and 16?
·
Would you be prepared to talk about your experiences?
Emily
Deacon, Trainee Counselling Psychologist at
To
find out more, contact Emily on: tel 07815964199 or emilydeacon@yahoo.co.uk
EDUCATION, EDUCATION, EDUCATION!
Nurses identify
barriers to good self-management and strategies to overcome them
If
you don't understand the title it means what stops us, people with diabetes,
from achieving 'good' management of our diabetes. This was addressed at an
American symposium [ref1] of 50 nurses and other health professionals. I don't
know about readers, but I find this irritating before I even start to read what
they actually think - it may be well intentioned but it seems patronising and
judgmental to not involve the views of people with diabetes.
Having
said this, most of the barriers they identified were not the fault of patients
but the fault of health systems. While these are views of health professionals
in
·
difficulty
navigating the healthcare system
·
the
lack of self-care education following diagnosis
·
limited
time with healthcare providers
·
under-valuation
of the importance of patient education
·
the
complexity of diabetes education
·
inadequate
patient health literacy.
None
of these 6 points are the fault of patients, not even the last one - they are
the fault of the health systems that are supposed to provide treatment, care
and education.
The
symposium’s solutions to these problems all centred around the importance of
education - need for more time with health professionals, developing better approaches to teaching
self-management and research to show the value of patient education [do we
really need yet more research on what is obvious?]. Finally they concluded that
health professionals "need to assume
that patients have a low level of health literacy and to use media other than
print, such as DVDs, in the educational process." Thanks a bunch! No
problems with using DVDs etc - they are very useful as they can be watched over
and over again but please don't assume that all patients have a low level of
health literacy - this really is patronising!
Has the term
'education' made the situation worse?
In
terms of ‘education’ we have to look at Type 1 and Type 2 diabetes separately -
they are different conditions that require different information and different
approaches.
If
we look back at Type 1 diabetes 30 years ago, we didn't have diabetes
specialist nurses, we didn't have many doctors who were specialists in diabetes
and paediatricians who specialised in diabetes were a rarity. But we did have
'patient education' although it was rarely referred to as such - in fact it was
automatically all part of diagnosis and treatment.
You
only have to attend an IDDT Conference to see that people who have had Type 1
diabetes a long time know how to count carbohydrates, know about the value of
exercise. If blood sugars are high, they don't simply inject more insulin but
mow the lawn or go for a long walk. They understand the relationship between
insulin, carbs and exercise. All this was achieved as a natural part of being
diagnosed with diabetes, it wasn’t called ‘education’ and there was no need for
research to prove its cost effectiveness!
So when did all
this change and why?
There
is probably a whole range of reasons but some are obvious:
·
people
with Type 1 diabetes used to see their hospital clinic doctor at least
6monthly, and more often if necessary, with time to talk through any problems
and what adjustments to make – ongoing ‘education’ although it wasn’t seen as
such. Now there is an annual MOT - less time with a specialist doctor and less
time for education. Moving people with Type 1 diabetes from hospital clinics to
GP surgeries has had questionable benefits, as many people report that they
know more than the GP!
·
Replacing
carb counting with 'healthy eating' in the late 1980s meant that people
received less 'education' about diet. Learning to count carbs automatically
meant learning to understand adjusting insulin and the relationship with
exercise. That carb counting is now
being seen as the way forward, DAFNE courses etc, brings a wry smile to some
us, but sadly there is a whole generation of people with diabetes and health
professionals who have an information gap that needs filling.
·
The
reliance on HbA1cs as a measure of blood glucose control has also had an
impact. Health professionals tend to think that a good result means that you
must be doing OK, so perhaps less time is spent on education? But it could be
that a good HbA1c is achieved by huge effort or because you are having lots of
hypos, so education is still vital.
·
More
complex insulin regimes have meant a greater need for education. Juggling 4 or
more injections a day, interpreting blood glucose results necessitates health
professionals spending longer with each patient, or it should. A little time
spent listening to the needs of each individual person, could reduce the need
for time consuming, complex education eg some people prefer two injections a
day.
Then there is Type
2 diabetes………
There
are huge numbers of people with Type 2 diabetes who also need education about
their condition and to add to this problem there are campaigns to diagnose more
people without the necessary education and care programmes being in place.
Again there is insufficient education about the value of diet and exercise and
as more people with Type 2 are being treated with insulin, this again requires
even more time spent on education.
Education costs
money…….
Patient
education was one of the targets in the National Service Framework for
Diabetes, so it should be available to all, but it costs money. Sadly Primary
Care Trusts [PCTS] do not seem to recognise education of people with diabetes
as a priority or that money spent on education now cannot be measured in immediate
costs but in savings on future costs. If more people end up as hospital
in-patients as a result of lack of education, at several hundred pounds a day,
then providing education now makes economic sense. But this seems to pass over
the heads of decision makers!
Where do we go from
here?
We
can't put right the wrongs of the past but we do have rights. If your locality
is not providing good care and good education to help you live with diabetes,
then write a letter of complaint to your local PCT. Don't do nothing - if
enough people complain there is a better chance that services will improve. In
complaining you are supported by a Health Commission Report on diabetes
services which says that the NHS is largely failing on diabetes self-care.
Remember, improving community services and the potential for self-management of
long-term conditions such as diabetes is also one of the government's key
policies.
Health Commission
report in diabetes services, July 2007
The
Report said PCTs in England were offering basic diabetes care such as yearly
check-ups but PCTs had to do better in supporting people to manage their
condition - just offering basic needs is not enough to prevent complications of
diabetes or for people's general wellbeing. It warned that almost 130 out of
more than 150 PCTs failed on home support - 73% were rated as 'fair', 5% were
rated as ‘excellent’, 11% were ‘good’ and 12% were ‘weak’. Being rated as
‘fair’ means people with diabetes are being given yearly check-ups and tests
such as for blood glucose and blood pressure levels and PCTs rated as 'fair' or
'weak' were not commissioning services that offered enough support to people
with diabetes to manage their condition.
The
Report recommended key improvements all providers of diabetes services need to
make:
·
Improve
care planning between people with diabetes and their health professional.
·
Increase
the number of people attending education courses.
·
Increase
the number of people having blood glucose levels of 7.4 or less.
·
All
providers and commissioners of diabetes services need to work more closely
together to reduce emergency admission rates
Your views: We'd
love to hear your views and experiences, write to Jenny Hirst, IDDT
Ref
1 "State of the Science on Nursing Best Practices for Diabetes
Self-Management," sponsored by the American Journal of Nursing. July 2007
COCHRANE REVIEWS
As
we have said before, Cochrane reviews help to make treatment decisions and here
a couple that may be useful:
Psychosocial
interventions for erectile dysfunction
A
meta-analysis was carried out looking at all the research for erectile
dysfunction to compare the effectiveness of psychological treatment [therapy]
and treatment with oral drugs, vacuum devices or other psychological
interventions. The reviewers searched for randomised controlled trials carried
out between 1966 and 2007 and found 11 trials involving 398 men. Their
conclusions were:
·
group
psychotherapy therapy improves erectile dysfunction in selected patients
·
focused
sex group therapy was more effective than no treatment
·
men
who received group therapy and Viagra [sildenafil] showed significant
improvement of erectile dysfunction and were less likely than those receiving
only Viagra to drop out
·
no
difference was found when comparing the effectiveness of psychological
interventions with local injection and vacuum devices.
Ref:
Melnik T, Soares BGO, Nasselo AG. Psychosocial interventions for erectile
dysfunction. Cochrane Database of
Systematic Reviews 2007, Issue 3. Art. No.: CD004825. DOI:
10.1002/14651858.CD004825.pub2.
Low Glycemic Index Diets Better for Weight Loss
A new Cochrane systematic review from
Low GI foods, such as lentils, sweet potatoes and
apples produce more consistent blood glucose levels compared to high GI foods
such as white rice and French fries. Previous studies suggest that keeping
blood sugar levels steady throughout the day may stimulate more weight loss so
the reviewers evaluated randomized controlled trials that compared weight loss
in people eating foods low GI foods to weight loss in people on higher GI diets
or other types of weight loss plans. The conclusions were:
·
Those eating low GI foods dropped significantly
more weight - about 2.2 pounds more than those on other diets.
·
Low GI dieters also experienced greater decreases
in body fat measurements
·
None of the studies reported adverse effects
associated with consuming a low glycemic index diet.
·
The low GI diet is more satisfying than other diets
so people are less inclined to feel hungry and therefore are more likely to
maintain this diet than other strict diets on which they feel hungry.
·
Low GI diets appear to be effective even in obese
people – obese low GI dieters lost about 9.2 pounds, compared with about 2.2
pounds by other dieters.
·
People eating low GI foods experienced greater
improvements in total blood cholesterol and LDL [bad] cholesterol.
The message really is that the success of low
glycaemic diets lies with the person’s
willingness to comply with its nutritional principles.
Ref 1. Low glycaemic index or low glycaemic load
diets for overweight and obesity. (Review)
DRUG
COMPANY FUNDING OF TRIALS GREATLY INFLUENCES THE OUTCOME
Researchers at the
·
if
the reported results favoured the
test drug, the trial was about 20 times more likely to be funded by the maker
of the statin rather than the comparison drug company.
·
if
the conclusions favoured the test
drug, the trial was about 35 times more likely to be funded by the maker of
that drug rather than the comparison drug.
The
significance of this study is that if drug trial outcomes are largely
determined by who pays for the trial, we don't really know which the best drug
is. We do need to know if a new drug really is better when compared to older
less expensive drugs.
PLos
Medicine,
MORE
INFORMATION ON AVANDIA – TO USE OR NOT TO USE? OLDER DRUGS ARE THE BEST!
In
the last Newsletter [July 2007] we reported details of a study published in the
New England Journal of Medicine suggesting that the risk of heart attack
increased in people using the Type 2 diabetes drug, Avandia. The advice in most
countries was ‘people using Avandia should not stop taking it’, but both
doctors and patients were left in a quandary.
Further
research was published in Diabetes Care, August 2007 involving over 78,000
people with Type 2 diabetes using rosiglitazone [Avandia] and pioglitazone
[Actos] which resulted in researcher at the
·
one
in every 50 people taking the drugs over a 26-month period will require
hospital admission because of heart failure which, according to lead researcher
Dr Yoon Loke, means that Avandia and Actos could have caused ‘thousands of
additional cases of heart failure’.
·
Heart
failure developed even in patients taking a high and a low dose of the drugs
and in some patients taking a lower dose than normally prescribed.
·
The
average time for heart failure to develop was 24 weeks after starting the
drugs.
·
Although
heart failure is thought to be a problem affecting older people, 25% of the
cases occurred in people under 60 - in both men and women
So
the researchers concluded that there is no particular category of patients who
are safe from these risks. The patient information leaflets for both Avandia
and Actos say that they should not be used in people known to have heart
failure but this study now suggests that the drugs can cause these problems in
people without a history of heart disease.
What is heart failure?
It occurs when the heart muscle is too weak
to pump as efficiently as it should.
Typical symptoms include breathlessness,
swollen ankles and feet, and extreme tiredness. People with heart failure are
more prone to potentially dangerous conditions such as: abnormal heart rhythms,
stroke and heart attack.
The
advice from the Medicines and Health products Regulatory Authority [MHRA] and
the European Medicines Evaluation Agency [EMEA] is that people should not stop
taking these drugs but if they are concerned, they should talk to their doctor.
Experts
at both the MHRA and the EMEA are re-evaluating the risks and benefits of both
Avandia and Actos and the results are due to be published later this year.
NICE, has said that if on the basis of the new research, the EMEA decides that
the risks caused by these two drugs outweigh the benefits, they will issue
updated prescribing advice which will take precedence over existing NICE
guidance.
In
July, the Food and Drug Administration [FDA] endocrine advisory panel voted
almost unanimously that Avandia should remain on the US market but made a
strong statement that it may increase the risk of cardiovascular disease.
On
A
separate FDA review of reports of side effects with Avandia and Actos, found
cases of weight gain and build up of fluids both of which are warning signs of
heart failure.
And a Cochrane Review recommends a very cautious approach
A Cochrane Review [ref 1] of Avandia led by Bernd
Richter, M.D., of
The reviewers pooled information from 18 randomized
controlled trials including more than 8,000 participants. About half of the
participants took Avandia and the others received either an alternative
medication or a placebo.
Avandia gave about the same reductions in blood
sugar levels as other oral antidiabetic drugs but when they looked at side
effects, diabetic complications or death, patients taking Avandia gained up to
11 pounds in weight and the chance of developing oedema doubled [swelling].
This indicates that the drug causes fluid retention, which can lead to
shortness of breath and heart failure. The largest single trial showed evidence
of raised cardiovascular risk, as well as increased numbers of broken bones in
women. Richter makes several points:
·
He questions "whether new studies with Avandia
will be ethical given the fact that less-dangerous therapeutic alternatives
exist.
·
Patients who suffer from heart disease, especially
congestive heart failure, should speak to their doctors about switching to
another antidiabetic treatment. If you are a woman, especially if you are thin,
you probably should avoid this medication due to the risk of bone fractures.
So what do people
with Type 2 diabetes do now?
When
the Avandia research first hit the news, the well known expert, Dr David Nathan
questioned why a drug that increases the risk of heart failure should be used
in people with type 2 diabetes who are already have an increased risk of it.
This seems to be a fairly sensible approach when other drugs are available!
What are your
choices?
Study shows that
older diabetes drugs are safe to use
A
study [ref 2] which began in 2005, before the fuss about
Avandia and Actos, carried out an depth
comparison of tablets for Type 2 diabetes, both old and new. It showed that
older, cheaper drugs for Type 2 diabetes are as safe or safer than newer ones.
Metformin stood out above the rest because it was less likely to cause weight
gain and more likely than others to lower ‘bad’ cholesterol levels.
The results were as follows:
·
all of the commonly used oral medications lowered
blood sugar levels in much the same way. Despite heavy marketing of the newer,
more expensive drugs, they showed no benefit unless a patient could not tolerate
an older one. Taking two medications can improve blood sugar control, but also
costs more and can raise the risk of side effects.
·
Metformin [Glucophage] stood out because it offered
the same level of effectiveness without causing low blood sugars, it lowered
LDL [bad] cholesterol, there was no weight gain and it is cheap. The main
drawbacks to metformin are digestive problems and diarrhoea. It can lead to a
build up of lactic acid in the blood in people with moderate kidney or heart
disease, so it should not be prescribed to anyone with either of these
conditions.
·
As with metformin, acarbose [Glucobay] does not
increase weight whereas other drugs add 2 to 11 pounds.
·
Sulfonylureas such as glimepiride, glipizide and
glyburide can cause hypoglycaemia [the other drugs don’t] and they appear to
have no effect on ‘bad’ cholesterol levels.
·
Avandia and Actos findings were similar to those
already discussed.
Conclusions of the researchers:
·
Metformin looks to be the safest drug with the sulfonylureas also being
highly rated.
·
Further studies are needed to compare the long-term effectiveness of one
treatment to another and to compare drug effects on quality of life and life
expectancy. Additional research is needed to compare these findings with
results for injectible medications, such as insulin and the new Byetta.
·
It is important that people weigh up their treatment options with their
doctor in order to make informed decisions about which medication suits their
needs.
If you have Type 2 diabetes, we hope that this goes
some way to help you make informed decisions about your treatment.
Ref 1. Richter B, et al. Rosiglitazone for type 2
diabetes mellitus (Review). Cochrane Database of Systematic Reviews 2007, Issue
3.
Ref
2. Annals of Internal Medicine, July 2007
INITIAL IMPRESSIONS OF
Part 2 - Adjusting
to life in the tropics and the impact on blood sugar control
By Jack Haves
Hello
again from a world outside the
I
arrived in
My
initial experience of
Adjusting
to the local diet proved to be painless and my blood sugar control was
fine. The Thai diet is highly reliant on
rice and noodles and these foods have a medium glycaemic index. This means the
energy is taken from the food more slowly compared to, for example, potatoes,
so rice and noodles are better for maintaining steady blood sugar levels.
One
thing I’ve largely avoided is traditional
Thai deserts as they’re highly sugary, but most of all particularly disgusting.
I’ll leave this to your own discretion of course! For the most part everything I’ve eaten in
Thailand (and I am eating traditional Thai food ) has been delicious and has
changed my opinion on certain foods forever - I now enjoy roasted insects and
if I’d been told that before I left the UK I would never have believed it.
Well,
as promised, I hope this has been a more entertaining chapter in the epic
journeys of Jack Haves. Next time I will
be coming to you with news of how I began teaching in my new home of Uthai
Thani, new friends/pupils, my teaching day, diabetes awareness in my community,
enduring rainy seasons and maybe a bit more.
PRODUCTS THAT MAY BE USEFUL…….
For your feet - as we all know
people with diabetes have to take care of their feet and regular inspection is
especially important for people who have reduced feelings in their feet due to
neuropathy [nerve damage]. The following products may be useful to you:
Loom Pedi Control
Telescopic mirror
- makes it easier to inspect your feet. It is a mirror 11cms in diameter on an
'arm' that extends to 54cms. One side of the mirror magnifies and the other is
simply a reflection. Cost - £9.99
Pediwand Footfile - a footfile for
removing dry skin from your feet, one side is course emery and the other, fine emery. Cost - £1.00
Dermasalve Foot
& Heel Cream - contains no known irritants and contains
natural oils like jojoba, aloe vera and wheatgerm to moisturise and sooth the
feet. Cost - £5.99 for 100ml
For your eyes - many people find
it quite difficult to put in eyedrops so that they don't run down the cheeks! Autodrop - is attached to the eye drop
bottle to ensure that the bottle is held over the eye at the correct angle so
that the dose is delivered in the right place. Cost - £2.99
These are all
available from Owen Mumford's Medical Shop, to order contact:
Medical Shop 0800
731 6959 or order online at www.medicalshop.co.uk
INSULIN DEVELOPMENTS
New technology that
may bring an insulin tablet nearer
A new drug delivery technology called Oradel has been developed by
an Australian
biotech firm, Apollo Life Sciences. It is able to deliver large molecules which have previously had to be injected,
in oral tablet form and the company's most advanced product is an
insulin tablet.
The problem with insulin in tablets has been that it is digested in the stomach
and therefore ineffective. Oradel allows the drug to survive the harsh enzymes
in the stomach by stabilising it within a protective structure that consists of
specific targeting agents which bind to naturally occurring transporters
embedded in the intestinal wall. This binding promotes the uptake of the
insulin [or other drugs] so that it crosses the intestinal wall and enters the
bloodstream where the Oradel structure breaks down, releasing the insulin into
the bloodstream.
In February 2007, Apollo announced successful results of toxicity studies in
rats and rabbits for the oral insulin tablet showing that Oradel loaded with
generic insulin was safe at both high and low doses. The slow-release
formulation also avoided spikes in insulin levels, allowing sustained insulin
release over at least eight hours. The insulin tablet will be entering clinical
trials later this year.
A
small
The
results of a small trial at
QDose may be a
better inhaled insulin than Exubera
A new inhalable insulin being developed by UK and US firms, has
just completed a glucose clamp study in the US and the results suggest that the
product could be better than Exubera, the first inhaled insulin recently to
come on the market.
According to the study, QDose showed relative bioavailability of inhaled
insulin at around 18 per cent compared to subcutaneous injection - 50-75 per
cent greater than Exubera.
The QDose system also showed dose equivalence, i.e. two 0.75mg blisters
delivering the same amount of insulin to the blood as a single 1.5mg blister.
This has been a downfall of Pfizer's Exubera, which has been unable to
demonstrate this dose equivalence, making dose decisions difficult for
patients. This relative bioavailability means that the actual insulin
requirement would be only a fraction of that required with Exubera so it would,
or should, be cheaper. A further advantage is that it requires no additives
unlike Exubera which contains mannitol, glycine and sodium citrate. The device
is an electronic dry powder inhaler, which uses piezo electronics to deliver
the chosen compound independently of the patient's inhalation flow rate.
Again
note, we will have to wait several years for this and for safety studies to
show no lung damage.
FROM OUR OWN CORRESPONDENTS
The old story of good prescribing
Dear Jenny,
I am a late
onset diabetic, FRCP physician aged 66 at diagnosis and regarded by some
classifiers as Type 1.5 rather than Type 2. You correctly point out in your
July 2007 Newsletter that Lantus [glargine] is not yet fully proven to be safe,
but to me as a patient, I have been subject to far too many severe hypos
needing ambulance resuscitation on a number of occasions when using Humulin L -
all of them daytime and usually associated with exercise.
This is the
old story of good prescribing, using the art of medicine to find out what suits
the individual patient best. In addition to Lantus, I use a quick-acting
insulin, I did get pork insulin on your suggestion for some months and it
worked perfectly well as a daytime insulin but became unavailable in
I have
professionally looked after diabetics myself for many years and understanding
diabetes as I do, gives me a great advantage over the average citizen. But you
correctly promote that if pork insulin suits a patient best, then he or she
should have it.
I am
interested in your publication and value its arrival. Congratulations on your
collective efforts.
Robin Scoular FRCP
Tauranga
Do you know about powdered
sweeteners?
Dear Jenny,
I thought
that readers of the IDDT Newsletter might be interested to know what Dr Richard
Bernstein has to say about the common sweeteners - Sweet'n Low, NutraSweet and
Splenda. "These are all
non-carbohydrate sweeteners that can be used to satisfy a sweet tooth without,
for the most part, affecting blood sugars.
But when sold in powdered form,
under such brand names as listed above, these products usually contain a sugar
to increase bulk and will rapidly raise blood sugar. They all taste sweeter
than sugar, so when you buy them in packets and powdered form, they usually
contain about 96% glucose or maltodextrin and about 4% artificial
sweetener. If you read the Nutrition
Facts on Splenda, for example, it lists ingredients in order from most to least:
dext
By e-mail
From one member to
another………
Dear
Jenny
Having
had to fight for a long time to be put on to pork insulin can I pass this piece
of advice on to other IDDT members: "If you think it may help you, demand the
change to Pork or Beef Insulin and see how it goes".
By
e-mail
Flying
DearJenny,
I read your
comments about drinks on flights in the July Newsletter. I have just returned
from a trip via
Mrs K.S.
IDDT
NEWS
IDDT
new leaflet - 'glossary of terms'
We have produced a new leaflet which
will help to explain the words and terminology that we hear as part of the
treatment of diabetes.
If you would like a copy of the new
leaflet 'Glossary of Terms', just get in touch - give is a ring on 01604
622837, e-mail enquiries@iddtinternational.org
or write to IDDT,
Don’t
forget your IDDT Christmas cards!
To those who have already ordered
them, many thanks for your help. If you haven’t got around to thinking about
Christmas yet, please think of buying ‘Fun
in the Snow’ IDDT cards. They are £3.25 per pack of 10 with 50p p&p a
pack up to a maximum of £3.00.
The
Despite a wet weekend and being
caught up in security problems, I am pleased to report that all our runners
made it – some quicker than others! Chris O’Malley was the first of IDDT’s team
to reach the finishing line. Many thanks to the runners but a huge thank you to
you, our members for raising nearly £2000 in sponsorship to help our cause. All
the sponsors names were entered into the prize draw and the winners of £50
Marks and Spencer’s vouchers were: D P O’
COMPULSORY
‘Insulin: A Voice for Choice’
By Arthur Teuscher
There can be no one who knows more about the human
and animal insulin debate than Professor Arthur Teuscher. After fully synthetic
insulin was made in 1975, he led the first clinical trial of synthetic insulin
in 6 people for 2 weeks and his subsequent article noted: “Two patients experienced more sudden hypoglycaemic events than with
animal insulin, but apart from that, synthetic insulin was well tolerated.” In
1977 he received a personal congratulatory note from Charles Best, the
discoverer of insulin.
Of Professor Teuscher’s new book, James Le Fanu,
MD, FRCP, Columnist for the Daily Telegraph and The Sunday Telegraph, writes:
“
Members of IDDT are part of this story, so if you would like a copy of ‘Insulin: a Voice for Choice’ it can be
purchased from IDDT for £11.50. To place an order, contact IDDT at
WARNINGS
Anti-obesity
drug, Accomplia!
Accomplia
[rimonabant]
is the most recently licensed weight loss drug in the
The
Drugs and Therapeutics Bulletin [Vol 45, No 6 June 2007] reviewed Accomplia and
described the adverse effects in the trials as follows:
·
Most
common - nausea [11-13% of patients], anxiety [5-8%] and dizziness [5-10%]. In
the trial with people with diabetes, 5% reported hypoglycaemia.
·
Around
15% of patients taking Accomplia withdrew from the trials because of unwanted
effects, mainly psychiatric disorders such as depression, anxiety, irritability
and insomnia.
But the
In
June 2007 the drug regulatory authority in the
Not so in
The other weight loss
drugs available in the
·
Xenical [orlistat] works by reducing
fat absorption from the gut was given marketing authorisation in 1998.
·
Reductil
[sibutramine]
which is an appetite suppressant, given marketing authorisation in 2004
Accomplia
has not been compared to other less expensive drug treatments for obesity. The
Drugs and Therapeutics Bulletin has previously concluded that Orlistat is a
reasonable option for obese people where diet, exercise and/or behavioural
methods alone have failed. When looking at Accomplia it still maintains that
this is the case because Orlistat has the most evidence for safety and
efficacy.
What NICE [National
Institute for Clinical Excellence] says about weight loss drugs: drug therapy for
weight loss should be considered for patients who have not reached their target
weight loss, or have reached a plateau with dietary, activity and behavioural
changes alone.
New warnings on
antidepressants [
Many
of you will remember the Panorama programmes about the prescribing of
antidepressants to children and adolescents and their increased risks of
suicidal thinking and behaviour. In 2005 the US Food and Drugs Administration
[FDA] insisted on changes in the labelling to warn of this and also began a
comprehensive review of 295 antidepressant trials. As a result they have now
proposed that makers of all antidepressants update their warnings on
their product labels to also include young adults aged 18 to 24 during initial
treatment.
People on
antidepressants should not stop taking them but if they have concerns, they
should discuss them with their doctors.
The
proposed changes also include statements that the scientific evidence did not
show this increased risk in adults over 24 and in people over 65
antidepressants show a decreased risk of suicidal thinking and behaviour. To
get this fully in perspective, the FDA is also reminding health professionals
that antidepressants benefit many people.
Note: this is an example
of post-marketing surveillance - drugs receive a marketing licence and after
licensing when used on the wider population, adverse effects appear which
require changes to the advice about a drug's use.
MRI -
Reminder for insulin pump users!
Medtronic
in
As
a result of new information, Medtronic now know that significant over-delivery
of insulin can occur following exposure to strong magnetic fields and have
issued the a warning: “YOUR PUMP MUST BE REMOVED AND KEPT OUTSIDE
THE PROCEDURE ROOM IF YOU ARE UNDERGOING MRI.”
PHARMACEUTICAL INDUSTRY NEWS
The
world's first digital insulin pen with memory
Lilly has produced a new insulin pen for use with Humalog. The HumaPen Memoir has a digital display that shows a record of the time, date
and dose of the last 16 injections to help both patients and physicians
to develop a diabetes treatment plan. It uses cartridges, has an internal
battery lasting three years, and it comes with a two-year warranty.
According to Lilly, the pen has been designed to look like a writing pen rather
than a medical instrument to make injecting in public more discreet.
Interesting, as the first insulin pens in the1980s were like writing pens - the
drug companies chose to make them large and instrument-like!
Memoir
was first available in
Eli Lilly also launched a second re-useable insulin pen product - the Luxura HD
pen, also for use with Humalog. It can deliver insulin in smaller doses with
1-30 units of insulin deliverable in half-unit increments after the first unit
and will be useful to those needing a small dose, especially children. Lilly
describe Luxura HD as a cousin of a Lilly
pen, Luxura, on the market in some European countries.
Impotence - once
daily Cialis given EU approval
A
once-daily version of Cialis, a drug to treat erectile dysfunction made by
Lilly and similar to Viagra, has received marketing authorisation from the
European Commission. It is the first drug of its kind to be used once daily.
Marketing authorisation for Cialis at 2.5mg and 5mg has been granted.
The
previous on-demand versions of Cialis at 20-mg and 10-mg doses have been
available in the EU since 2002, but at a maximum recommended dose of one tablet
per day taken shortly before sexual activity. In contrast with this and other
products, this once-daily formulation of Cialis eliminates the requirement to
have sex within a narrow time frame. According to the company, the once-daily
version is intended for men intending to have sex at least twice a week.
Lilly expects the launch of the new doses in selected countries during the
second half of 2007 and continuing throughout other EU countries during 2008.
The recommended dose is 5mg a day, but can be reduced to the 2.5mg level based
on individual tolerability.
Victory for the
belief that people, not profits, must come first in public health.
Pharmaceutical
giant Novartis challenged the law that allows
message
ELECTRONIC
PRESCRIPTIONS
The
Department of Health has announced the first Primary Care Trusts [PCTs]
selected to use the Electronic Prescriptions Service.
The following PCTs have been
selected to go live from
No earlier than from
Haringey
Legal electronic NHS prescriptions
can only be issued where the patient has:
·
nominated
one or more dispenser in his NHS Care Record,
·
has
confirmed that he intends to use that dispenser (or one of them) for the
purposes of obtaining the drugs, medicines or appliances ordered on the
electronic prescription,
·
consented
to the use of an electronic prescription on the particular occasion. Therefore,
for the time being, the only time that pharmacists will be required to dispense
against the electronic message is where the prescription has been sent using
the nomination functionality.
Plain English people - what's the
Nomination Functionality?
It is the patient’s choice which
dispenser they choose to nominate.
The NHS
Regulations 2004 are clear that a prescriber must not persuade a patient to
nominate a dispenser recommended by the prescriber. If asked to recommend a
dispenser, the prescriber is to provide a list of dispensers that operate the
electronic prescription service [provided by the PCT]. The NHS (Pharmaceutical
Services) Regulations 2005 prohibit pharmacies and appliance suppliers from
offering inducements to encourage nomination of a pharmacy.
NHS NEWS
NHS Choices -
website www.nhs.uk
This
is what we are told! NHS Choices is a service that aims to put you at the
centre of your healthcare to help you make choices about your health, [little smile!] from lifestyle decisions
to the practical aspects of finding and using NHS services. The aim is provide
straightforward information that will help you ask your doctor the right
questions about your health and any treatment you need [little smile!]. Then, with the doctor, you can decide on the
course of action that’s right for you – what treatment and, as far as possible,
when and where to have it. [Important
statement for those who don't receive a choice of insulins!]
NHS
Choices gives [1] information on how to live a healthier life, [2] guides on
the most common procedures, such as hip replacements, and conditions including
diabetes and depression and [3] helps you and your GP pick the best provider
for treatment or surgery and in 2008 you will be able to compare hospitals on
their records for particular treatments or procedures, their cleanliness
figures, rates of hospital-acquired infections, details of car parking and
waiting times.
Even
if you don’t have a computer at home you can use of NHS Choices as all the
material can be printed out, transferred to DVDs or made available through your
GP, local library, or from any computer.
Complaints against
GPs rise
The
two leading GP insurance companies, which cover 9 in 10 GPs in
Optometrists to get
independent prescribing powers
Optometrists [ophthalmic opticians] are to get independent prescribing
powers - specially trained optometrists
will be able to write a prescription if they diagnose a problem with the eyes
and the surrounding tissue that needs treatment. They will still refer patients
to an ophthalmologist for more specialized care.
Government to renegotiate
NHS drug pricing,
The
Office of Fair Trading (OFT) recently issued a report on the pricing of drugs
recommending replacing the current price and profit controls with a value based
approach that will provide value for money for the NHS, better incentives to
invest for companies and a more sustainable, stable system.
The
Government’s interim response was to agree that it was time the system was
updated: "We agree with the OFT that it is time to develop a pricing
system which is fit for purpose for the twenty first century.”
Liberal
Democrat Health Spokesperson, John Pugh MP said: “The relationship between the pharmaceutical industry and the British
Government has been far too cosy for too long. This re-negotiation is a very
welcome development. British taxpayers are paying some of the highest prices in
the world for branded medicine. The current scheme is confusingly complex but
has historically suited the pharmaceutical industry."
Association
of British Pharmaceutical Industries [ABPI] was more measured, stating that
they 'welcome the assurance from the
Government that any new agreement will recognise the contribution of the
pharmaceutical industry to the
We'll
see what 2010 brings!
Poor and late
hospital discharge information is putting patients at risk
GPs
are supposed to receive information on medicine and treatment within 2 days of
a patient being discharged from hospital to help in their follow-up care. The
information is e-mailed, faxed or given to the patient to hand over. An NHS
Alliance poll of 651 GPs found 70% often received papers late and many said the
forms were incomplete and lacked important details that compromised patient
safety including the patient's name,
contact details, medication and treatment. In one instance, a discharge summary
was received but failed to mention that the patient had just spent a week in
intensive care following a stroke and heart attack.
58%
of GPs reported the problems meant clinical care was compromised in the last
year, with 39% claiming patients had been put at risk but nearly two-thirds of
doctors said they had hospital teams in their areas who provided good, prompt
information, proving it could be done. A Dept of Health spokeswoman said
officials were looking to draw up a contract for hospitals in a bid to improve
discharge information. [Why on earth is a contract necessary for something that
should be done as a matter of course?]
NICE Is developing
guidelines on diabetes and pregnancy
The
National Institute for Health and Clinical Excellence [NICE] is currently
developing guidelines on diabetes in pregnancy. These will cover the management
of diabetes and its complications from pre-conception to the post-natal period
and is expected to be published in November 2007.
SNIPPETS
HSC News global
Quality of Life Survey
There are interesting findings in a global survey of people with a 'disability'. The most valuable factors that could improve their quality of life and identified as ‘very important’ by 75% of the respondents, were:
· getting the correct treatment/care/support.
· healthcare professionals sufficiently skilled/expert to do the job.
· doctors who listen to patients’ opinions about treatment and care.
·
not having to battle the system to receive the
needed care.
Handshakes with your
doctor
Research carried out in the
Believe it or not,
patients are now getting more time with GPs
GPs in
· The average consultation time in 2006/07 was 11.7 minutes, up from 8.4 minutes.
· The number of consultations carried out by GP practices has risen - but the number of home visits has dropped from 9% of the total to 3%.
· GPs are working roughly the same surgery hours as they did when the last survey was carried out in 1992/93 but most are not working outside "normal" hours as they once did. In 1992/93 the average GP worked around seven hours a week outside surgery hours.
· The number of consultations at family practices across England has risen from 220.1 million in 1995 to 289.8 million in 2006 but a higher proportion are now undertaken by nurses - in 1995 it was one in 5 and now it is one in three.
· The number of consultations has remained constant but the number of telephone consultations trebled from 3% to 10%.
Katherine Murphy, of the Patients Association told the BBC
that the GP service was getting worse despite the "inflated salary"
of family doctors and that "trust and relationship is very quickly being
eroded. They are not delivering patient-friendly service."
Taking a break during
exercise
Research in
Fat cats……
Research at