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Hot Topics Blog

'Hot Topics' GP Update Course Spring 2018 - Course Preview

Simon Curtis - 28 Mar, 2018

The Hot Topics GP Update course is a fun, inspiring and informative day packed with learning points to take away to use in practice. We make it easy for you to maintain focus on the day by keeping our presentations short, sharp and focussed with lots of opportunity for interaction. We use clinical cases weaved in to bring the literature and guidelines to life. There are NO pharmaceutical reps or sponsors at any of our events; we are 100% ‘pharma free’. All the presented material will be completely new compared to Spring 2017.

All delegates on the course will receive:

  • ·The detailed 300 page Hot Topics paper book
  • A bigger electronic version of the book, including even more Hot Topics. This is hyperlinked to all the original references and is instantly searchable
  • The NB Medical App, across which you can access the full content of the digital course book or just the Keep it Simple Summaries (KISS)
  • Pre and post course MCQs to assess learning
  • The Webcast version of the course following the course so that you can review and see the material again
  • The personal email address of the presenters of the course for post course follow up questions

Topics that we shall cover on the day will include:

  • Cardiovascular medicine

o  Atrial fibrillation, the latest developments including the DOACs

o  Hypertension looking at treatment targets, starting with combination therapies and home monitoring

  • Diabetes

o  The main learning points from the new SIGN guideline, including what next after metformin?

o  An update on flash glucose monitoring

o  Diabetes remission and reversal

  • Respiratory

o  Making practical sense of the new NICE Asthma guidelines

o  COPD, the new GOLD guidelines encourage a completely new approach to management

  • Musculoskeletal

o  Gout, looking at new evidence and guidelines which change practice

  • Women’s Health

o  Living with breast cancer

o  Vaginal discharge and also self-taken swabs

o  Implications for patients who have had vaginal prolapse mesh repairs

  • Prescribing Hot Topics

o  Does everyone on low dose aspirin or antiplatelets need PPI cover?

o  What about the long-term risks of PPIs? Who should be on long term PPIs and at what dose?

o  Gabapentinoids, the latest developments on risks and benefits

o  DMARDs, new UK guidelines on DMARD monitoring

  •  Cancer

o  Platelets as a cancer marker…how should we respond to a raised platelet count?

o  CT screening for lung cancer

o  Colorectal cancer in young people

  • · Skin

o  Acne, new evidence and guidelines and the implications of rising antibiotic resistance

  • Mental Health

o  Depression, including the recent systematic review on antidepressants

o  Eating disorders, including new nice guidance

  • Infections

o  Is it really penicillin allergy?

o  New NICE guidance on sore throat, sinusitis and otitis media

o  Scarlet fever cases are at a 50 year high…how should we diagnose it and respond?

o  New evidence looking at UTIs and antibiotic choices

  • Gastroenterology

o  Could your patient with reflux have eosinophilic oesophogitis?

o  How doe we manage abnormal LFTs?

  • ·Paediatrics

o  New NICE guidance on faltering growth in children

o  Abdominal migraine in children

  • Miscellaneous cases to end the day

As ever, we like to keep it practical and pragmatic whilst also considering many of the broader issues and challenges we face (from GP Burnout to Overdiagnosis). And we like to have a laugh too!

We look forward to seeing you!

Simon, Neal, Gail, Kevin, Siobhan, Kate, Zoe, Ahmed, Rob and Stephanie - The NB GP Team


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The Pharmacological Management of Type 2 Diabetes

Rob Walker - 22 Mar, 2018

It’s been an up and down sort of a Six Nations for the Scottish Rugby team but I must give my congratulations to my colleagues North of the Border (as well as the Irish and the French…) for not only a good old-fashioned thumping in Edinburgh (which my North Berwick NB colleague was quick to point out…) but also for overtaking England in the final standings. Whilst on the subject of Scottish successes, SIGN have produced an excellent guideline on the pharmacological management of type 2 diabetes (http://www.sign.ac.uk/assets/sign154.pdf). In it SIGN have made a few significant changes to recommendations on drug management options in patients with type 2 diabetes and established cardiovascular disease.

Jimmy is 58 years old and has had type 2 diabetes for 8 years. His lifestyle left a little to be desired in the past - he smoked heavily, was overweight and ended up having an acute coronary syndrome 4 years ago. However, the ACS spurred him into changes - he gave up smoking, lost some weight and his glycemic control since has been stable on a full dose of metformin. However, despite his best efforts you see him for his annual check with a current Hba1c of 60 (7.6%), which has been creeping up over the past 12 months. He has got a BMI of 33, has no peripheral neuropathy, has good pedal pulses on doppler and has a stable eGFR >60. He remains on secondary prevention for CVD (aspirin, ramipril, atorvastatin and bisoprolol) as well as his metformin. So where should we go now? He feels he is doing everything he can from a lifestyle point of view and you both agree that lowering his Hba1c with drug escalation will be of benefit for reducing his risks of further complications. But what medications should we consider for Jimmy?

Until recently I suspect many of us will have been using the NICE guidance on drug intensification, and the excellent KISS on ‘what next after metformin' done by my colleague Kevin Fernando, to help decide what medication to use next. However, since the NICE guidance was published we have had the results of some significant trials looking at cardiovascular disease outcomes, including EMPA-REG, CANVAS and LEADER. These trials are important as they looked at hard outcome data (cardiovascular end-points) rather than surrogate markers (Hba1c). These trials have been incorporated into the the new SIGN guideline 154 (with a very good accompanying algorithm - http://www.sign.ac.uk/assets/diabetes_algorithm.pdf) which is the first to explicitly recommend particular drugs for patients with established cardiovascular disease. In summary SIGN recommend that in patients with type 2 diabetes and established cardiovascular disease drugs with proven cardiovascular benefits (currently empagliflozin, canagliflozin and liraglutide) should be considered

So back to Jimmy. You decide with him to go by the recent SIGN guidance and based on their algorithm you use an SGLT2 inhibitor, either empagliflozin or canagliflozin, and arrange a follow up Hba1c in 3 months. As Jimmy leaves the room, you can’t help wonder though…..more drugs - is this really the right answer? Well, there could be another option to discuss with him next time if he is motivated. Is aiming for remission of his diabetes through weight loss, and reducing his treatment burden, a realistic goal and is there any evidence for it? A subject for another discussion, including the results of the DiRECT trial, which we will have for you as part of our Spring Hot Topics update!


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