Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
The Village Medical Centre Gt Denham Kingswood Way, Great Denham Bedford, MK40 4GH Dr. Andrew Gray Mob: 07775693753 Fax: 01234 244025 E-Mail: [email protected] Tel:01234 244000 Web:www.gtdenham.org BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE 12TH SEPTEMBER 2007 I attended this Committee for the first time on behalf of Horizon at Steppingley Hospital. Many issues were discussed, but of the most immediate importance Clinically and Economically was EXENATIDE (Byetta) in the management of Type 2 Diabetes. This is from a new class of Drug with significant benefits over and above the Glitazones and Insulin for people who fulfil the following criteria BMI > 30 Hba1c > 8% Recommended as Add-on to double therapy May be used instead of a Glitazone with Monotherapy. The backdrop is that Glitazones are suddenly seeming a far less favourable option, especially in the Obese group. There are currently significant numbers of patients attending Secondary Care in this category where there has been considerable reluctance to initiate Insulin therapy. It is proposed to start treatment with these. Advantages of Exenatide over Insulin Standard daily dosage Does not cause Hypoglycaemia Produces a fall in BMI whereas Insulin causes a rise Does not require all the paraphernalia of frequent blood sugar testing Produces a fall in Hba1c of up to 1% Disadvantages of Exenatide Twice daily s/c self injection Nausea which proves intolerable in possibly 40% of patients It is expensive £830 per pt. p.a. The Village Medical Centre Gt Denham Kingswood Way, Great Denham Bedford, MK40 4GH Dr. Andrew Gray Mob: 07775693753 Fax: 01234 244025 E-Mail: [email protected] Tel:01234 244000 Web:www.gtdenham.org Proposal Initiate Exenatide therapy at the Diabetic Clinic for those already attending Secondary Care to provide the first month of therapy only. Secondary Care to train Nurses and GPs Prescribing transferred to Primary Care while monitoring continues at Secondary Care It was also proposed that ALL our patients who might benefit should be referred to Secondary Care for change-over of treatment. I and other GP reps opposed this last point as we believed that after a few months of experience with prescribing for Hospital Initiated cases, and following strict criteria for Patient Selection, the costs of Out Patient appointments for patients currently managed in Primary Care seemed unnecessary. We believe that within a few months, GPs with a responsibility for Diabetes could confidently manage this case-load. This proposal will return to the December meeting at Steppingley where I expect it to be actioned. I attach their Business Case and a brief account of the Drug itself. Added benefits are that the significant efforts employed when putting Type 2s on Insulin will be avoided, Control will be improved so improving Quality and Outcomes, all at a modest overall increase in costs. Andrew Gray Other Decisions Grazax was NOT approved for seasonal Pollen Allergy. Champix for Smoking Cessation looks very promising, but will not be approved until the Smoking Cessation Service has adequately trained their ‘Counsellors’ to properly select the appropriate patients.