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Diabetes 9 – Clinical Guidelines vs Clinical
Reality, Dipesh Patel
Speaker key
IV
DP
Interviewer
Dipesh Patel
DP
My name’s Dipesh Patel, a consultant in diabetes and endocrinology and I work at the
Royal Free Hospital.
IV
What was your talk about today?
DP
Today I’m talking about the clinical guidelines in the management of Type 2 diabetes
where I’ll review some of the conventional treatments and look at some of the newer
treatments on the horizon to manage these patients.
IV
What are the new developments in the field over the last five years?
DP
So in the last five years we’ve had a number of increases in classes of drugs to use to
address hyperglycaemia or raised blood glucose. These include GLP-1 or Glucagon-like
peptide-1 receptor agonists, DPP-4 inhibitors and the newer SGLT2 inhibitors which work on
the kidney.
IV
Are they on the Camden formulary for hospitals or GPs in the area?
DP
So both GLP-1 receptor agonists and DPP-4 inhibitors can be used in hospitals and in
primary care, so will be on the joint formulary. The newer agents that work on the kidney,
classed as the SGLT2 inhibitors, haven’t quite made the regional formularies yet but there is
no restriction of use as they have been nationally endorsed by something called NICE, by a
technology appraisal.
IV
What advances will there be in the next five years in treatment for patients?
DP
So in the next five years I think it’s an exciting time for diabetes. We are having more
and more treatments available to hopefully stem the progressive decline in beta cell or
pancreatic function. So hopefully we would think in the next few years we will be able to halt
the decline of the function of the pancreas so that we don’t have to add in a number of
medications every so often to the patients as we’re doing now. So some of the classes will
include more gut peptide therapies like the GLP-1 receptor agonists, there are combinations
of insulin and GLP-1 receptor agonist to be used together on the horizon and there are newer
insulins and biosimilar insulins that will be available for use in the coming years. Hopefully
combining these treatments together, obviously along with patient engagement, we’ll be able
to perhaps change the natural history of Type 2 diabetes.
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IV
What new treatments will be available in primary care or will they be hospital
treatment only?
DP
So I think the traditional or conventional paradigm between oral therapies available in
primary care and injectable therapies only available in secondary care is changing. We now
have community tier three services where patients can access newer treatments. Some of the
newer oral treatments will be available in primary care and secondary care due to the fact that
we now have joint formularies and access to both. And I think we’re changing the paradigm
of newer treatments only being available in hospitals but I still think specialists should be
involved in the supervision of patients on newer treatments and auditing patients on newer
treatments.
IV
What does the future hold for prognosis?
DP
So hopefully with the advent of newer and newer therapies that we could use in a lot
of our patients, the “Cinderella” for Type 2 diabetes is really halting that progressive decline
in pancreatic functional beta cell function. So if we can halt decline in pancreatic function,
patients will hopefully stay with good glucose levels and avoid some of the avoidable
complications that are associated with diabetes.
IV
Is there anything else that you’d like to say?
DP
I think it’s a challenging time for diabetes in terms of the numbers of people we’re
seeing with diabetes. But on the other hand I think it’s a very promising area where we’re
getting newer and newer treatments available for patients and hopefully we will be able to
stem the progressive nature of Type 2 diabetes.
IV
Where can GPs find out more?
DP
So GPs can find out more by going online to the Camden Diabetes website but also to
the National Diabetes UK website which is both for patients and healthcare professionals.
People can get hold of me via the switchboard at the Royal Free Hospital.
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