PJ Online | News: New diabetes care guidelines in Scotland

The Pharmaceutical Journal Vol 267 No 7175 p733-738
24 November 2001

New diabetes care guidelines in Scotland

New guidelines on the management of diabetes have been launched by the Scottish Intercollegiate Guidelines Network (SIGN).

The guidelines cover issues in the care of children with diabetes, lifestyle modification, management of diabetic cardiovascular disease, nephropathy and foot disease, prevention of visual impairment, and management of diabetes in pregnancy.

For management of diabetic cardiovascular disease, the recommendations state:

Metformin should be considered as a first-line oral hypoglycaemic agent in patients who are overweight.
Hypertension should be treated aggressively, with a target diastolic blood pressure of below 80mmHg.
Aspirin should be considered for all patients who have well-controlled hypertension with a coronary event risk greater than 20 per cent over 10 years.
Following myocardial infarction, intensive insulin therapy, thrombolytic therapy, beta-blockers, aspirin, angiotensin converting enzyme (ACE) inhibitors and cholesterol-lowering medication should be considered.

In order to prevent diabetic nephropathy, good glycaemic control and tight blood pressure control should be maintained, the guidelines say. Glycosylated haemoglobin (HbAlc) should be maintained at around 7 per cent and blood pressure below 140/80mmHg. Patients with microalbuminuria or proteinuria should be started on an ACE inhibitor and considered for angiotensin II antagonist therapy. Good glycaemic and blood pressure control is also important for prevention of onset of diabetic visual impairment.

For diabetic foot disease, painful neuropathy should be treated first-line with tricyclic antidepressants. Gabapentin and topical capsaicin can also be tried.

For children and young people with diabetes, the guidelines recommend that glycaemic control should be optimised towards a normal level to reduce the risk of long-term microvascular complications. Women with diabetes should aim to have blood glucose levels between 4 and 7mmol/L before and during pregnancy.

The guidelines were published on 14 November and can be found on the SIGN website (www.sign.ac.uk).

The National Service Framework for England and Wales on diabetes was expected to be published this autumn but has been delayed.

Diabetes management The management of diabetes should become pharmacy-based, according to Dr Simon Fradd, deputy chairman, General Practitioners Committee and chairman, Doctor Patient Partnership.

Dr Fradd was speaking at the Wessex Pharmaceutical Group NHS conference held in Basingstoke this week. He pointed out that diabetes had moved from being a hospital based to a general practice based condition. "I would now like to see a move to pharmacy," he said.