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Hot Topics Blog

Free NB Medical Webinars

NB Medical - 15 Nov, 2018

You can access the recent FREE NB Medical Webinars by registering on the following links:

Hot Topics Headaches in Primary Care Webinar - Aired June 6th 2018

Hot Topics Men's Health in Primary Care Webinar - Aired July 12th 2018

Hot Topics Women's Health in Primary Care Webinar - Aired September 12th 2018

Hot Topics Diabetes in Primary Care Webinar - Aired November 14th 2018

Plus! Available for the first time. Watch the 'Hot Topics' Autumn 2018 GP Update LIVE from the comfort of your own home. Simon and the team will be presenting the ‘Hot Topics’ GP Update course broken down into 4 x 90 minutes sessions. Cost £195. Don’t worry if you miss a session, all sessions will also be available on demand. You will receive all the benefits of attending a ‘Hot Topics’ course:-

* 6 hours of learning CPD in the comfort of your home

* A comprehensive course reference book

* 12 months online access to the course reference book

* 12 months access to all 4 session presentations, (review and refresh all the presentations and information you heard on the day)

* Free to download, the NEW NB APP - access your information on the go via your mobile phone

* A KISS from NB - new and updated KISS summaries (Keep it Simple Summaries) sent to you on a monthly basis

* Automated upload of your CPD into your Clarity Appraisal Toolkit

* Discounted subscription to NB Learning and access to over 100 hours of online modules.

The Webinar is split into four separate sessions which will take place on the following dates/times:

Session 1 - Wednesday 3rd October – 7.30pm - 9pm

Session 2 - Wednesday 10th October – 7.30pm - 9pm

Session 3 - Wednesday 17th October – 7.30pm - 9pm

Session 4 - Wednesday 7th November – 7.30pm - 9pm

Register here: ‘Hot Topics’ Webinar Sessions x 4 

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Cardiovascular outcome data in type 2 diabetes, does it really matter to me and my patients?

Sarah Davies - 8 Nov, 2018

So, we’ve heard about all this recent “exciting” cardiovascular outcome data in type 2 diabetes, but is there a real tangible benefit to our own patients outside of a clinical trial setting? How should we be incorporating it into our own clinical practice?

Over the last ten years the explosion in the number of type 2 diabetes medications available has been overwhelming and made decision making a lot more difficult. There is much talk of the cardiovascular protective effects seen in CV outcome trials with several of the SGLT2 inhibitors and GLP1 agonists, but it can be difficult to relate these clinical trials to everyday decisions we are making on the ground. The NICE 2015 type 2 diabetes guidelines, while sturdy and still allowing good individualised care, are becoming rapidly outdated by this new data and were always somewhat “wordy” on the eye. In November 2017 the SIGN 154 guidelines came out from Scotland which began to clearly incorporate some of the new evidence. Last month the American Diabetes Association and the European Association for the Study of Diabetes jointly brought out a new user-friendly treatment algorithm (ADA/EASD 2018 guideline) which reflects a lot of the new evidence and how to relate that to our own primary care patients. 

Instead of thinking of type 2 diabetes as mainly a disease of managing hyperglycaemia, there has been a real shift towards thinking of it as managing overall cardiovascular risk. The current evidence for cardiovascular protection with the newer agents is in secondary prevention, in the presence of pre-existing cardiovascular disease. The ADA/EASD algorithm guides us down a particular path depending on cardiovascular disease state, as well as the presence of chronic kidney disease, where we also have evidence for protective effects from some of the newer medications.

 For example, if Mr P has pre-existing CV disease, has already been established on metformin and requires further intensification, they guide us to using an SGLT2 inhibitor or GLP agonist which has been proven to improve cardiovascular outcomes in secondary prevention (currently empagliflozin, canagliflozin, liraglutide and semaglutide, the latter will be available to prescribe in the UK from Jan 2019). If Mrs S requires a second line medication but does not have CVD or CKD, it guides us to make a choice depending on the degree of need to: avoid hypoglycaemia, promote weight loss, or avoid high costs. This reflects good individualised patient care.

The algorithm is well worth a look and makes incorporating the new data into our prescribing choices in type 2 diabetes very clear. Of course, as we have seen, the research is moving at a ferocious pace and later this month we will have data from another CV outcome trial on an SGLT2 inhibitor which looks at the potential role in reducing CV risk in primary prevention. This obviously represents a large proportion of our own patients. A similar study is also following for a GLP1 agonist. Both of these studies have already announced top line positive findings, details still to follow. This may well yet again alter our thinking. It may even be that in future these medications will be used increasingly in a cardiovascular setting, above and beyond the treatment for hyperglycaemia - stay tuned and we will keep you updated!

Want to know more? We're presenting our Diabetes for Primary Care Course in, Milton Keynes, London & Bristol, over the next few weeks, and will cover from diagnosis through to HBA1c targets, diabetes in the elderly, prevention and remission of type 2 diabetes, a detailed look at pharmacological options with all the recent evidence included and a look at complications.- why not come along?

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Log in to your NB Dashboard and use the 'Add Reflective Note' button at the bottom of a blog entry to add your note.