GPs get tough new diabetes targets
By Lilian Anekwe
GPs will be asked to implement an intensive programme of weight reduction and lipid lowering for patients with diabetes as part of ambitious new proposals from NICE.
All patients with type 2 diabetes over the age of 40 will be eligible for treatment with a statin under the draft guidance, due out next week.
And NICE has gone some way to toughening up its diabetes cholesterol targets – although not far enough to appease some critics.
But it is the institute's new weight loss target – perhaps a precursor for a future indicator in the quality and outcomes framework – which is likely to prove most controversial.
GPs will be expected to deliver a reduction in body weight of between 5% and 10% in overweight or obese patients with diabetes – a target experts admitted would be ‘very difficult' to achieve.
The draft will also ask GPs to lower total and LDL cholesterol to 5 and 3mmol/l or below respectively – or to 4 and 2 in patients with additional cardiovascular risk factors.
A source told Pulse the committee had been limited in its options on cholesterol targets, as any disparity with the draft NICE guidance on lipid modification would have ‘looked silly'.
Other recommendations will include a new, tightened HbA1c target of 6.5% for almost all patients and a blood pressure target of 140/80mmHg.
The expected recommendations drew a mixed reaction from GPs and diabetes experts.
Dr James Mather, diabetes lead for Worcestershire PCT and a GP in Malvern, warned the 5-10% weight reduction target, though reasonable, would be very challenging.
‘It's very difficult because it's behavioural, and there's a limit to how much a GP can help. But that's what we should aim for. It's another one of those things that makes a difference but we only have meagre resources to do it.'
Professor Anthony Barnett, a consultant in diabetes at Birmingham Heartlands hospital, said not setting a lipid target of 4 and 2 while also recommending an HbA1c level of 6.5% was ‘paradoxical'.
He added: ‘It's going to be difficult for the majority of people to reach 6.5%, but that's the idea. We should be trying for the greatest gains – so why not go for 4 and 2?'
Professor Peter Sever, professor of clinical pharmacology at Imperial College London, said recommending statins for all patients with diabetes over 40 ‘made an awful lot of sense', but that it was disappointing NICE had stopped short of a 4 and 2 target.
Professor Sever, who led the ASCOT blood pressure trial, said: ‘It's a political and financial decision as it so often is with NICE. To set a target of 5 and 3 is completely arbitrary and is simply based on cost.'Statins: to be used after tough new diabetes guidelines from NICE Statins: to be used after tough new diabetes guidelines