People at high risk of diabetes should undergo intensive lifestyle change, says NICE

All people in England at high risk of developing type 2 diabetes should be offered a place on an intensive lifestyle change programme, says updated guidance from NICE | BMJ

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The guidance now states that anyone with a fasting glucose concentration between 5.5 and 6.9 mmol/L should be offered a place on such a programme but that priority should be given to anyone with a reading between 6.5 and 6.9 mmol/L, because of their increased risk of developing diabetes.

The guidance also states that anyone aged over 40 (except pregnant women), people aged 25-39 of south Asian, Chinese, African Caribbean, or black African origin, and people from other high risk ethnic minority groups should be offered a diabetes risk assessment, carried out at a general practice or a community pharmacy.

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NICE guidance: managing medicines

NICE has published Managing medicines for adults receiving social care in the community

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This guideline covers medicines support for adults (aged 18 and over) who are receiving social care in the community. It aims to ensure that people who receive social care are supported to take and look after their medicines effectively and safely at home. It gives advice on assessing if people need help with managing their medicines who should provide medicines support and how health and social care staff should work together.

Full guideline: Managing medicines for adults receiving social care in the community

People who are dying should be asked about their spiritual beliefs

NICE has published new guidance calling on healthcare professionals to ask adults in the final days of life about their religious or spiritual beliefs.

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Cultural preferences and spiritual beliefs should be included in discussions about the care a person, and those close to them, want to receive, says NICE.

Knowing if someone holds a religious belief can be important for providing the care they desire. For example, someone who is Catholic may wish to receive the last prayers and ministrations.

The 2016 End of Life Care Audit reported nearly half of all deaths in England occurred in hospital. Spiritual wishes were only documented for one in 7 people who were able to communicate their desires.

Read the full overview here

Read the full guidance here

NICE guideline update – Surgical site infections: prevention and treatment

Surveillance report 2017 – Surgical site infections: prevention and treatment (2008) | NICE guideline CG74

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Surveillance decision: We will plan an update of the guideline on prevention and treatment of surgical site infections. The update will focus on:

  • nasal decontamination of Staphylococcus aureus
  • choice of preoperative skin antiseptics
  • application of intraoperative topical antiseptics/antimicrobials before wound closure
  • type of suture.

We will consider intraoperative perfusion and hydration, and intraoperative blood glucose control in a new guideline on perioperative care. Recommendations in the surgical site infection guideline will be withdrawn on publication of new recommendations in the perioperative care guideline.

Read the full update here

End of life care for infants, children and young people

NICE has published new NICE guidance: End of life care for infants, children and young people with life-limiting conditions: planning and management (NG61).

This guideline covers the planning and management of end of life and palliative care in for infants, children and young people (aged 0–17 years) with life-limiting conditions. It aims to involve children, young people and their families in decisions about their care, and improve the support that is available to them throughout their lives.

Additional link: NICE news report

Commentary on NICE and SCIE guidelines: transition between hospital and community or care home

Winfield, A & Burns, E. (2016) Age Ageing. 45 (6) pp. 757-760.

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Image source: Alex Williamson – Wellcome Images // CC BY-NC-ND 4.0

Safe and appropriate transition between inpatient settings and the community is one of the major challenges facing the modern NHS. The National Institute for Health and Care Excellence in conjunction with the Social Care Institute for Excellence published guidance on this challenging area in December 2015. This commentary provides context, summary and discussion of the key areas covered. The guidance particularly emphasises the importance of a person-centred approach in which patients are individuals and equal partners in the multidisciplinary team who should be treated with dignity and respect.

Read the full article here

NICE recommends new triple therapy option for type 2 diabetes

Wise, J. (2016) BMJ.355:i5472

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Image source: NICE

Dapagliflozin (marketed as Forxiga) has been recommended as part of triple therapy for patients with type 2 diabetes, giving doctors another prescribing option for patients with uncontrolled blood sugar.

Draft guidance from the National Institute for Health and Care Excellence (NICE) has recommended dapagliflozin in combination with metformin and a sulfonylurea as an option for treating type 2 diabetes in adults. NICE said that it had fast tracked appraisal of the drug so that final guidance could be published sooner and benefit people more quickly.

Dapagliflozin is already recommended as monotherapy when metformin is contraindicated and as dual therapy with metformin. It is a selective sodium glucose cotransporter 2 (SGLT-2) inhibitor, which blocks reabsorption of glucose in the kidneys and promotes excretion of excess glucose in the urine. Two other drugs in the same class, empagliflozin and canagliflozin, are already recommended for triple therapy.

The clinical experts said that in addition to lowering HbA1c, SGLT-2 inhibitors also lowered blood pressure. Another benefit of the SGLT-2 inhibitors was weight loss, they said. This is particularly important given the strong association between type 2 diabetes and excess body weight, and some treatments, such as insulin, can also result in weight gain.

Read the full commentary here

Read the draft NICE guidance here