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The end of trust?

NHS prescribing advisers have opened the door to soaring statins bills after ruling the drugs should be considered

in all patients with type 2

diabetes ­ regardless of lipid levels.

It is the first time a Government body has come out in support of prescribing statins universally in diabetes as evidence grows for their benefits in patients across the cholesterol spectrum.

Around a million patients with type 2 diabetes are currently not receiving a statin; treating them all would cost an estimated £360 million a year.

The National Prescribing Centre's latest MeReC Extra bulletin concludes it is 'reasonable' to consider treating all patients with type 2 diabetes with a statin 'even if lipid levels are normal'.

Dr Neal Maskrey, the centre's medical director, said: 'Overall there is increasing evidence that statins are worthwhile in most patients with diabetes and we can't get away from that.' He said the decision reflected a move away from a 'blood glucose-centric' approach to diabetes control.

The bulletin was funded by NICE and will have important implications for NICE guidance on blood lipid control in type 2 diabetes, due for review in October. The bulletin added that for patients at low cardiovascular risk, the 'incremental benefit' of statins over other primary prevention measures 'may not justify their additional cost'.

But a senior adviser on the current NICE guidelines told Pulse other treatments should be dropped in favour of statins if cost was a concern.

Professor Paul Durrington, professor of medicine at the University of Manchester, said: 'When people want to reduce the use of statins, usually on cost grounds, they ignore the fact that the evidence for hypoglycaemic drugs is poor whereas the evidence for statins is very good.'

Current NICE guidance restricts statins to patients with LDL cholesterol over 3mmol/ litre and research suggests even these patients often miss out on treatment.

Dr Eugene Hughes, Isle of Wight GP and member of Primary Care Diabetes Europe, said: 'We have been dithering for too long. I would say everybody should be on a statin unless there are serious contraindications.'

The centre reviewed data from the landmark Heart Protection Study and CARDS

trial.

By Cato Pedder

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