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NICE bows to pressure to re-open consultation on ‘bonkers’ diabetes guidelines

Exclusive NICE chiefs have agreed to accept a second round of feedback on updated type 2 diabetes clinical recommendations, after their original draft guidance was branded ‘bonkers’ by GP experts.

NICE said it was opening a second consultation on Friday 26 June after ‘universal’ requests from stakeholders – despite previously insisting there were no grounds for a second consultation.

Professor Mark Baker, director of clinical practice at NICE, told Pulse that after further consideration the regulator agreed a new consultation ‘was the right thing to do’ after so many changes were made to the original document.

The draft guidelines caused widespread dissent from diabetes experts over revamped advice on glucose-lowering treatments, which they said was nonsensical and based too much on cutting costs, and risked making NICE ‘a laughing stock’.

Professor Roger Gadsby, a GPSI in diabetes, said that experts were branding the guidance ‘bonkers’, while an editorial in the British Journal of Diabetes and Vascular Care said the guidance would ‘set back modern diabetes management by decades’.

NICE informed stakeholders last month that ‘substantive’ revisions had been made to the draft recommendations after the initial consultation on the recommendations – but said no further consultation was needed as no new analyses had been conducted.

But Pulse has learned that after giving the request ‘further consideration’, NICE has now agreed to open the revised version for further scrutiny.

Professor Baker said: ‘We’ve given further consideration to the requests from our stakeholders for a second consultation on the draft type 2 diabetes guideline. We have agreed that holding a second consultation on the updated section of the draft guideline is the right thing to do, in view of the number of changes made to proposals on the therapies for managing diabetes, and the universal stakeholder requests to see the changes. 

‘We’ve updated our stakeholders to let them know that this focused consultation will run from 26 June until 24 July, and we hope that this extra step will further reassure stakeholders of the robustness of our proposed recommendations.’

Dr David Millar-Jones, chair of the Primary Care Diabetes Society (PCDS), which led the calls for a second consultation, said it was ‘great news’ that NICE had changed tack.

Dr Millar-Jones said: ‘The PCDS has been concerned that the original draft guidance would be subject to confusion and place patients at risk.

‘We drafted a letter to NICE expressing our concerns. This was supported by other organisations who are leaders in clinical management. Despite little acknowledgement and several emails asking for review of the “substantive changes” that we were told had been made, we are delighted that this has now been put forward for a further consultation.

‘We look forward to reviewing the new therapeutic advice and hope that it is a document that we can now support.’

Readers' comments (7)

  • NICE, JEREMY HUNT and The Daily Mail.....3 damn good reaons to leave General Practice. I am 45 years old and am desperately thinking of an exit strategy from this "Vitam Horribilis".

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  • Samuel Lewis

    |" this focused consultation will run from 26 June until 24 July, and we hope that this extra step will further reassure stakeholders of the robustness of our proposed recommendations."

    I do hope NICE sticks to its guns, and will not give way to the Pharma-funded Specialist-driven hype - eg: unevidenced newer anti-glycaemic agents.

    RCT evidence must dominate over 'expert' opinion. remember Rosiglitazone ? For ten years we were killing more than we saved !

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  • Do be aware folks that failure to adhere to these so called "guidelines" can in some circumstances expose you to litigation for which there appears to be no defence. In my experience defence union "expert" GP opinion regards a breech of NICE guidance as negligent or as a "breech of duty of care". It is unfortunate that the defence organizations are not prepared to challenge NICE's ever changing diktat's - but of course it costs them less to pay of the litigant patient than defend the poor old doc!!

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  • Samuel Lewis



    ??

    i reckon its t'other way about - Practicing Medicine will expose you to litigation..

    Following NICE guidance is a defence.
    Following the practice of a reasonable body of peers is a defence (Bolam).
    Following well-evidenced or authoritative practice is a defence.

    doing whatever you fancy at the time outwith the above is not a defence.

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  • Vinci Ho

    Am I fair to say that to 'treat' NICE , one has to be ' not so nice'??

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  • "Following the practice of a reasonable body of peers is a defence (Bolam)" - this isn't always the same as (blindly?) following NICE guidance though is it? Nor does it equate to "doing whatever you fancy at the time". As a poster above kindly reminds us:
    "The institute’s recommendations are advisory for GPs and sometimes almost aspirational in nature" writes NICE chair Sir Michael Rawlins.

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  • Samuel Lewis

    I agree with anonymous that following NICE is often not the same as following other experts, or doing what a reasonable body of peers would do.

    That is the whole point. EACH of these positions is defensible, whilst 'kissing it better' or rubbing it with snake oil, is not.

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