Public HealthDiabetologists Sound Caution Over Extended Role Of New Drugs
The Association of British Clinical Diabetologists cautioned against indiscriminate use of new classes of medication for Britain"s increasing number of people with diabetes.
ABCD, which represents more than 500 consultants physicians and registrars in Britain specialising is diabetes, said oral gliptins and injectable incretin mimetics needed "careful adoption" to meet their full treatment potential.
They shaped their views after carrying out a research study into one of the new therapies - exenatide - in which they analysed the experiences of more than 7,000 patients.
Their position statement on the safety and effectiveness of these type of drugs is published in the June edition of Practical Diabetes International.
It offers a new and unique "patient dimension" to the updated guidance that was issued this week by NICE.
ABCD do suggest that new types of oral and injectable medication - used as an alternative to insulin - have an important role to play in the improvement of glycaemic control in a selected number of patients with obese type 2 diabetes.
But the Association advised against a routine role for these drugs at this early stage, after its research highlighted the need for careful patient selection.
Patients at risk of pancreatitis, such as those with a high alcohol intake; a history of gall stones; or on steroids, should only be considered for exenatide under specialist medical supervision with careful monitoring, it warned.
Bus and lorry drivers with diabetes, as well as patients who have undergone or who are contemplating bariatric surgery, also require specialist input in selection for exenatide use.
Over the last two years, ABCD has built up considerable experience in the prescribing of oral gliptins and injectable incretin mimetics. It has drawn upon this expertise to identify "best practice" in their future use.
ABCD chairman, Dr Peter Winocour, said the Association"s research, combined with the long-awaited NICE guidance, placed an important spotlight on the future treatment regimes for diabetes.
He said: "By pooling our expertise, ABCD is in a unique position to share our experience throughout the diabetes community - and ensure that patients continue to receive the highest possible quality of care.
"These drugs are welcome additions in the fight against diabetes but, as with anything new, they need careful adoption and must be used judicially.
"We have been able to identify the appropriate cohort of patients who may benefit the most from these therapies. We recommend widening their use in some groups - but urge caution in others, especially those with abnormal liver and kidney function."
The views of ABCD were informed by a confidential web-based audit among its members regarding the use of exenatide, one of the new injectable therapies for obese type 2 diabetes.
It also took into consideration limited NICE guidance published previously as well as the findings of other diabetes specialists across America and Europe, who have also suggested a more restricted role for these "less well-validated therapies".
ABCD"s preliminary position statement will now inform drug prescribing and clinical practice among diabetes experts nationwide.
Dr Winocour added: "We have learned from past experience with other novel diabetes therapies that adverse side effects can become apparent even after pre-licensing testing. Our audit will help to identify adverse effects sooner rather than later, ensuring the right treatments continue to be provided to the right patients in the right way.
"The potential positives and negatives of all treatment options need to be carefully employed and discussed fully so informed decisions can be made in partnership with the patient.
"We are also advising that patients are fully aware of potential side effects, such as abdominal pain, nausea, vomiting and early satiety."
Association of British Clinical Diabetologists