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Nurses claim NICE diabetes guidance will put patients at risk

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Nurses claim new official guidance on drug treatments for type 2 diabetes has set the field “back 20 years” and could put patients at risk.

The guidance on the pharmacological management of blood glucose in adults with type 2 diabetes is due to be published by the National Institute for Health and Care Excellence later this year.

But it has been criticised for actively recommending a limited range of treatments that may not be the best options for some patients.

The draft guideline has been consulted on twice but some nurses, charities and drugs companies have expressed concern.

“[The 2009 guidance] felt like NICE was giving us the ability to choose what was best for the individual. But the new draft took away all of that”

Debbie Hicks

“The 2009 version was very much about individualising care and making the patient the centre of the consultation,” said Debbie
Hicks, co-chair of Training Research and Education for Nurses in Diabetes.

“It incorporated all the classes of drugs… and felt like NICE was giving us the ability to choose what was best for the individual. But the new draft took away all of that.”

One issue, highlighted by Diabetes UK, is that some recently approved drugs are only mentioned in passing, such as sodium-glucose co-transporter-2 (SGLT-2) inhibitors, which the charity says now risk being overlooked.

It is also concerned about the prominence given to sulphonylureas, which can cause weight gain and increase the risk of hypoglycaemia.

Ms Hicks, also a nurse consultant for diabetes at Enfield and Haringey Mental Health Trust, said she would like NICE to carry out a third consultation in light of the ongoing concerns.

Royal College of Nursing

Marina Lupari

“There’s a feeling that what we’re doing in the UK is going back 20 years,” she said.

Marina Lupari, professional lead for primary care and community nursing at the Royal College of Nursing, said the guidance aimed to ensure greater consistency.

However, she added: “NICE has gone for the most frequently used drugs and those that will have the most frequent impact. We need to develop the evidence base on the impact so we know more about why one drug works so effectively in one person and not everyone.”

A NICE spokeswoman confirmed that the feedback would be considered when drawing up the final version, due to be published this autumn.

  • 2 Comments

Readers' comments (2)

  • The clue is in the title 'guidelines'. Professional judgement can override these as long as you justify your decision.

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  • Guidelines are guidelines but some medicine management leads follow NICE to the letter which makes it harder for clinicians to put patients at the centre of the prescribing decision instead of making the consultation about the costs

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