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Thursday 28 May 2015

NICE makes substantial changes to 'bonkers' diabetes guidelines after GP criticism

Exclusive NICE has made ‘substantial’ changes to its draft diabetes guidelines after its initial proposals were described as ‘bonkers’ and threatened to make the institute a ‘laughing stock’.
A number of pressure groups, led by the Primary Care Diabetes Society (PCDS), have called on NICE to re-consult on the changes to the guidance, expressing concern that final guidelines are still due to be published in the summer ‘without further consultation with the major stakeholders’.
But Pulse has discovered that NICE will not put the revised guidelines out to consultation because no new analyses have been undertaken since the draft guidelines were published.
As revealed by Pulse, the draft guidelines were heavily criticised in particular over updates to the management of glycaemic control, with one expert describing the draft recommendations as ‘bonkers’, while others warned they risked making ‘a laughing stock’ of NICE.
The criticisms were particularly focused on the use of repaglinide as an alternative first-line therapy in people who cannot tolerate metformin, with experts pointing out that this has not been widely used since its launch in the 1990s.
But NICE has told Pulse that it has made changes, although there is little indication around what these changes entail.
Professor Mark Baker, director of clinical practice at NICE said: ‘We thank our stakeholders for taking part in the consultation on the management of type 2 diabetes in adults NICE guideline update. The NICE Guideline Development Group has carefully considered the comments received on the draft guideline, and has made changes as a response to the consultation.’
The letter stated: ‘As registered stakeholders that responded to the draft update to the guidelines, the Association of British Clinical Diabetologists and the Royal College of Physicians of London were encouraged to learn that the GDG had subsequently made “substantial changes” to the draft recommendations.’
However, they called upon NICE to give relevant groups the opportunity to see the changes, and comment on them before they are published.
The letter continued: ‘We are writing to ask whether NICE intends to give stakeholders an opportunity to comment on the revised guideline before it is published in August. If not, we would urge you to consider doing so, to ensure the maximum possible support for this important document.’
This followed a letter sent by Primary Care Diabetes Society (PCDS) chair Dr David Miller-Jones, which was backed by the ABCD and patient groups, also called for further consultation on the guidelines before publication.
It said: ‘The original draft guideline has caused considerable concerns and was felt to be cumbersome and likely to cause confusion in non-specialist care. It was felt that this guideline would put patients at risk and lead to errors in their management.’
It added: We are concerned that the final guideline is due for publication without further consultation with the major stakeholders. We are keen to support a guideline that reflects current, safe and prudent health practices and feel that further consultation should be sought before final publication.’
NICE’s manual on developing guidelines states that a second, four-week consultation on proposed guidelines may be undertaken under ‘exceptional circumstances’ - for example if ‘information or data that would significantly alter the guideline were omitted from the first draft, or evidence was misinterpreted in the first draft and the amended interpretation significantly alters the draft recommendations’.
However, Professor Baker told Pulse that a second consultation was ‘not required’ because no new analyses had been undertaken in order to revise the draft document.
‘As no new systematic reviews, modelling or analyses have been performed as a result, a second consultation was not required.’
I always thought the present NICE diabetes guidelines were bonkers anyway.
Graham

7 comments:

Anonymous said...

Speaking of bonkers, what have you done with 'Shootin' Blanks'
He's been thankfully quiet lately, and has been letting the grown ups post some useful stuff, rather than the rubbish he always spouts off.
You didn't push him outside and forget to push him back in again?
Mind you, you probably would notice it was a lot more peaceful.
Slap him down enough, you may even get a fourth poster on the 'Dead Forum' again!

Lowcarb team member said...

Anonymous said...

Speaking of bonkers, what have you done with 'Shootin' Blanks'

Not done anything with 'Shootin' Blanks'had no drivel to delete today, maybe his mummy has found out about his nefarious troll activity on the internet and he's now sat on the naughty step. LOL

Graham

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Lowcarb team member said...

@'Shootin' Blanks'

I have deleted your comments because as per DCUK forum rules you have gone off topic and derailed the thread.

I'm taking this course of action due to you being supporter of DCUK it's only fair you abide by their forum ethos, any further breach of the rules will result in a permanent ban from this blog so please keep on topic.

Kind regards
Love and hugs
Graham

PS I just deleted your latest deluded rant

Lowcarb team member said...

Spotonski Graham

That Shooting blanks is shot away, very aptly named I reckon.

Eddie