NICE diabetes targets 'too tough'
By Lilian Anekwe
Stringent targets set by NICE for lowering cholesterol and blood pressure in patients with diabetes are unrealistic and leave GPs struggling to meet them, new research suggests.
The study casts further doubt on whether the tough new QOF cholesterol targets to be set from April will prove achievable without high levels of exception reporting.
Two audits found that that a third of patients did not achieve the institute's total cholesterol targets and only a third reached the toughest blood pressure targets – despite patients taking recommended treatment.
NICE guidance on type 2 diabetes, published in May last year, urged GPs to implement an intensive programme of lipid and blood pressure lowering.
GPs are expected to lower total and LDL cholesterol to 5 and 3mmol/l and blood pressure to 140/80mmHg. Targets are even tougher in patients with additional cardiovascular or microvascular risk factors, at 4 and 2mmol/l and 130/80mmHg respectively.
But an audit of 73 patients attending a diabetic clinic in the first three months of 2008 who were primarily managed in primary care found 43% had a ‘suboptimal' lipid profile. Of 66 attending a diabetic renal clinic, two-thirds of patients had inadequately controlled cholesterol, despite all being prescribed simvastastin 40mg.
A second audit of 60 patients managed in primary care but attending diabetic outpatient clinics found almost half had a blood pressure above the lowest NICE target of 140/80mmHg. Both studies were presented at the Diabetes UK conference this week.
Study leader Dr Parijat De, a consultant in endocrinology at the city hospital in Birmingham, concluded: ‘Recent NICE guidelines suggest using 80 mg of simvastatin or adding ezetimibe in patients not meeting targets; the latter may be a more worthwhile, evidence-based and effective option, particularly in general practice, albeit at a higher cost.'