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NICE move on inhaled insulin

By Gareth Iacobucci

NICE has relaxed its conditions on the need for psychological assessment of needle phobia before patients can qualify for inhaled insulin.

Experts welcomed the move, which they said could widen access to the drug, but warned many people who are averse to injecting would still miss out.

The final NICE guidance has been modified after stakeholders criticised restrictions in the draft document, warning psychiatric provision was inadequate to cope.

Barring a last-minute appeal, the recommendations, which allow inhaled insulin to be prescribed in needle-phobic patients after assessment by a diabetes specialist, will be pub- lished in full in December.

Some experts suggest up to a third of patients suffer from needle phobia. In June this year NICE backtracked from its initial ruling against any use of inhaled insulin on the NHS.

Professor Anthony Barnett, clinical director of diabetes and endocrinology at Heart of England Foundation Trust and respondent to the NICE consultation on behalf of the Assoc- iation of Clinical Diabetologists, welcomed the move. 'I'm happy that NICE have listened to the experts and reconsidered their original decision,' he said.

But he believed the guidance could have gone further. 'There will be a lot of people who may not be needlephobics but who are sick to death of injecting. In my area, a large proportion of people would fall into this bracket. At any one time, about 10 per cent of our south Asian patients desperately require insulin, but are refusing it largely because of aversion to injections.'

Dr Richard Rigby, a GP in Twickenham, south London, and GPSI in diabetes, said: 'I do not think they need a psychology assessment to assess needlephobia, and not all specialist centres even have access to psychologists.'

But he added that the recommendation from NICE that all initiation, treatment and monitoring of inhaled insulin should be undertaken at specialist diabetes centres raised questions about the roles of GPSIs in initiation of treatment.

Dr Martin Hadley-Brown, chair of the Primary Care Diabetes Society and a GP in Thetford, Norfolk, said: 'I am pleased to see that NICE has not totally ruled out the use of inhaled insulin, but has identified the circumstances in which it can most appropriately be used.'

giacobucci@cmpmedica.com

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