Épisodes

  • From AI to Reality: Navigating Multimorbidity in diabetes with NICE Guidelines

    From AI to Reality: Navigating Multimorbidity in diabetes with NICE Guidelines
    Oct 17 2023
    This episode makes reference to guidelines produced by the "National Institute for Health and Clinical Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE.My name is Fernando Florido and I am a GP in the United Kingdom. In today’s episode I look at a fictitious clinical case of a patient created by Chat GPT to see how the NICE guidelines could apply to it.  I am not giving medical advice; this video is intended for health care professionals, it is only my interpretation of the guidelines and you must use your clinical judgement.   There is a YouTube version of this and other videos that you can access here: There is a YouTube version of this and other videos that you can access here: The Practical GP YouTube Channel: https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrkThe patient was created using the following Chat GPT prompt: A)   Provide a fictitious patient. Details that you should include are: 1)   patient's medical information including:·      name·      age·      sex·      ethnicity·      BMI·      blood pressure2)   medical history- you must include:·      either one or two of the following poorly controlled conditions: ·      type 2 diabetes·      hypertension ·      dyslipidaemia, ·      Asthma or COPD·      Any number of other medical conditions of your choice, along with whether they are well controlled or not – the medication for these conditions should appear in the next section “medications”Medications given:·      indicate whether the patient is currently taking medication for each medical condition or not.·      If medication is prescribed for a condition, indicate the specific drug(s) and their dosages. You may choose to prescribe one, two, or three drugs for each condition as appropriate.3)   State whether the patient tolerates the medication well or not, and if not, describe the side effect(s) and their severity.4)   blood test results (give a bulleted list but do not number them):·      HbA1c expressed in % and mmol/mol·      renal function tests to include creatinine (expressed first in µmol/L and then in mg/dL), eGFR, urea, sodium, and potassium (expressed in UK units first and then USA units) ·      lipid profile expressed both in mmol/L first and then in mg/dL.·      If the patient has asthma, give the peak flow reading expressed as a percentage of their best or expected reading.·      If the patient has COPD, give the FEV1 reading expressed as a percentage of the predicted reading ·      include any other relevant test results for the patient, expressing them in both UK and USA units. If the patient has hypothyroidism or takes levothyroxine medication, provide the results of their thyroid function tests, including both T4 and TSH levels, in both UK and USA units. Also, include the normal range for these investigations.B)  Provide the patient's cardiovascular risk using the QRISK2 tool, calculated as a percentage of the likelihood of experiencing a cardiovascular event over the next 10 years. C)   At the end of the patient information, ask: 'What treatment recommendations would you make?' – do not make recommendations yourselfD)  Do not include a disclaimer that the patient is fictitious. The NICE hypertension flowcharts can be found here: Website: https://www.nice.org.uk/guidance/ng136/resources/visual-summary-pdf-6899919517 Download: https://1drv.ms/b/s!AiVFJ_Uoigq0lgKKs3AbARF_VLEI?e=KRIWrn  The full NICE Guideline on hypertension (NG136) can be found here:  Website: https://www.nice.org.uk/guidance/NG136 Download: https://1drv.ms/b/s!AiVFJ_Uoigq0lgP6nFVHRypL9fdj?e=Jbtgus  The full NICE Guideline on Type 2 diabetes (NG28) can be found here:  ·      https://www.nice.org.uk/guidance/ng28  The full NICE guidance on cardiovascular disease risk reduction (CG181) can be found here: ·      https://www.nice.org.uk/guidance/cg181The full NICE guidance on asthma (NG80) can be found here: ·      https://www.nice.org.uk/guidance/ng80 The full NICE guidance on depression in adults (NG222) can be found here: ·      https://www.nice.org.uk/guidance/ng222 The full guidance on obesity (CG189) can be found here:·      https://www.nice.org.uk/guidance/cg189  Thumbnail photos- From: www.freepik.com·      Image by Freepik: Image by a href="https://www.freepik.com/free-photo/excited-young-friends-running-beach_9057871.htm#page=2&query=45%20year%20old%20obese%20woman&position=10&from_view=search&track=ais"Freepik/a  Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]   Music provided by Audio Library Plus   Watch: https://...
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    12 min
  • Real life complex patient: NICE on diabetes, hypertension, hypertriglyceridemia and hypothyroidism

    Real life complex patient: NICE on diabetes, hypertension, hypertriglyceridemia and hypothyroidism
    Jul 30 2023
    My name is Fernando Florido and I am a GP in the United Kingdom. In today’s episode I look at a real-life case to demonstrate how the guidelines could apply to it. By way of disclaimer, I am not giving medical advice; this video is intended for health care professionals and you must use your clinical judgement. The PDF version of this episode can be found here:·      Colour version: https://1drv.ms/b/s!AiVFJ_Uoigq0l3MBwm5sUpEybW8r?e=xio6pz·      Printer friendly version: https://1drv.ms/b/s!AiVFJ_Uoigq0l3RhABLRM2_pQQOz?e=jzuMxbThere is a YouTube version of this and other videos that you can access here:·      The NICE GP YouTube Channel: NICE GP - YouTubePrescribing information links:·      Website: https://cks.nice.org.uk/topics/diabetes-type-2/prescribing-information/dpp-4-inhibitors/·      Download PDF: https://1drv.ms/b/s!AiVFJ_Uoigq0liBvuQq8_0Cd-GSz?e=NnL56J·      Website: https://cks.nice.org.uk/topics/diabetes-type-2/prescribing-information/glp-1-receptor-agonists/·      Download PDF: https://1drv.ms/b/s!AiVFJ_Uoigq0liFRycIZPaVfj-lC?e=a2QTNY Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-throughTranscriptHello everyone and welcome. My name is Fernando and I am a GP in the United Kingdom. We have looked at fictitious patients in previous episodes but, in today’s episode, I am going to look at a real diabetic case to see how the guidelines could apply to it. And as you know, we are focusing only on the pharmacological treatment. If you want to download a PDF version of this episode, the link is in the episode description. Please note that I am not giving medical advice; this is only my interpretation of the guidelines and you must use your clinical judgement Remember that there is also a Youtube version of these episodes so have a look in the episode description.Right, so let’s get straight into it. The details, which have been anonymised, belong to a real patient, so we have 46-year-old man of Asian descent with T2DM who presents with the following: HbA1c is 68 mmols/mol/8.4% (therefore poorly controlled) Cholesterol 5.9 Triglycerides 5.72 HDL 0.97 ·      The path lab has not calculated LDL because triglycerides >4.5 ·      Liver and Renal function tests are normal with an eGFR of 97  Thyroid function tests show a borderline low T4 of 9 (NR 9-19.1) and a raised TSH of 9.88 (NR 0.35-4.94 ACR normal FBC and other routine blood tests were normal.  His BMI is 32, so he is obese His BP is 147/89 His PMH includes: Hypothyroidism T2DM His regular treatment is with: Levothyroxine 200mcg daily Metformin 500 mg TDS He comes to discuss his test results, feeling well in himself. His obesity is long-standing and being managed with diet and lifestyle advice. He has had hypothyroidism for 15 years and, on prompting, he says that he is feeling a little tired So, let’s have a look at the guidelines. As usual I will focus on the NICE guidelines and we will have to looks at the guidelines on type 2 diabetes, hypertension, prevention of cardiovascular disease, and hypothyroidism  Let’s look at his diabetes first. Firstly, NICE says that we need to consider if rescue therapy is necessary for symptomatic hyperglycaemia with insulin or a sulfonylurea. However, he is well and asymptomatic so we do not have to do this. We see that his current dose of metformin 500 mg 3 times a day is not enough to control his diabetes. So, given that his renal function is completely normal.  we should increase the dose to the maximum of 2000mg daily, that is, 1000mg twice a day. However, this is unlikely to be enough to bring his HbA1c of 68 or 8.4% to target. And let’s remember that according to NICE we should strive for the following targets: ·      Lifestyle management only— 48 mmol/mol (6.5%). ·      A single drug not associated with hypoglycaemia (such as metformin) — 48 mmol/mol (6.5%). ·      Drug treatment associated with hypoglycaemia (such as a sulfonylurea): 53 mmol/mol (7.0%). ·      Always adjust for people who are frail, elderly or with other co-morbidities This patient is young and otherwise well so we should aim to treat him aggressively. NICE says that for people not controlled on metformin alone, we should consider dual therapy but which?  We need to assess the person's cardiovascular status and risk to determine whether they have chronic heart failure, established atherosclerotic cardiovascular disease, or are at high risk of developing cardiovascular disease. This patient does not have heart failure or cardiovascular disease but using an online calculator, his 10-year QRISK3 score is 12%. So, being over 10%, we will consider him at high risk of developing CVD.  And NICE says that if the patient is at high...
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    13 min
  • Chat GPT patient meets NICE: This is what happened!

    Chat GPT patient meets NICE: This is what happened!
    Apr 28 2023
    "Chat GPT Patient Meets NICE - Here's What Happened!" My name is Fernando Florido and I am a GP in the United Kingdom. In today’s episode I look at a complex random clinical case of a patient created by Chat GPT to see how the NICE guidelines could apply to it. By way of disclaimer, I am not giving medical advice; this podcast is intended for health care professionals, it is only my interpretation of the guidelines and you must use your clinical judgement.  There is a YouTube version of this and other videos that you can access here: The NICE GP YouTube Channel: NICE GP - YouTube ChatGPT prompt to create a patient:  A)   Provide a fictitious patient. Details that you should include are: 1)   patient's medical information including:·      name·      age·      sex·      ethnicity·      BMI·      blood pressure2)   medical history- you must include:·      either one, two or three of the following poorly controlled conditions: ·      type 2 diabetes·      hypertension ·      dyslipidaemia, ·      Any number of other medical conditions of your choice, along with whether they are well controlled or not – the medication for these conditions should appear in the next section “medications”Medications given:·      indicate whether the patient is currently taking medication for each medical condition or not.·      If medication is prescribed for a condition, indicate the specific drug(s) and their dosages. You may choose to prescribe one, two, or three drugs for each condition as appropriate.3)   State whether the patient tolerates the medication well or not, and if not, describe the side effect(s) and their severity.4)   blood test results (give a bulleted list but do not number them):·      HbA1c expressed in % and mmol/mol·      renal function tests to include creatinine (expressed first in µmol/L and then in mg/dL), eGFR, urea, sodium, and potassium (expressed in UK units first and then USA units) ·      lipid profile expressed both in mmol/L first and then in mg/dL.·      include any other relevant test results for the patient, expressing them in both UK and USA units. If the patient has hypothyroidism or takes levothyroxine medication, provide the results of their thyroid function tests, including both T4 and TSH levels, in both UK and USA units. Also, include the normal range for these investigations.B)  Provide the patient's cardiovascular risk using the QRISK2 tool, calculated as a percentage of the likelihood of experiencing a cardiovascular event over the next 10 years. C)   At the end of the patient information, ask: 'What treatment recommendations would you make?' – do not make recommendations yourselfD)  Do not include a disclaimer that the patient is fictitious. The NICE hypertension flowcharts can be found here: Website: https://www.nice.org.uk/guidance/ng136/resources/visual-summary-pdf-6899919517 Download: https://1drv.ms/b/s!AiVFJ_Uoigq0lgKKs3AbARF_VLEI?e=KRIWrn  The full NICE Guideline on hypertension (NG136) can be found here:  Website: https://www.nice.org.uk/guidance/NG136 Download: https://1drv.ms/b/s!AiVFJ_Uoigq0lgP6nFVHRypL9fdj?e=Jbtgus  The full NICE Guideline on Type 2 diabetes (NG28) can be found here:  ·      Overview | Type 2 diabetes in adults: management | Guidance | NICE The full NICE guidance on osteoarthritis (NG226) can be found here: ·      Overview | Osteoarthritis in over 16s: diagnosis and management | Guidance | NICE The full NICE guidance on cardiovascular disease risk reduction (CG181) can be found here: ·      Overview | Cardiovascular disease: risk assessment and reduction, including lipid modification | Guidance | NICEThe full NICE guidance on asthma (NG80) can be found here: ·      Overview | Asthma: diagnosis, monitoring and chronic asthma management | Guidance | NICE The full NICE guidance on depression in adults (NG222) can be found here: ·      Overview | Depression in adults: treatment and management | Guidance | NICE Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]   Music provided by Audio Library Plus  Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript  Today we'll be exploring the world of NICE guidelines and how they apply to a complex patient. But this isn't just any patient - this one was randomly created by the latest buzz in town, ChatGPT. Our focus will be on the pharmacological treatment.Hello and welcome, I'm Fernando Florido, a GP in the United Kingdom.Before we dive in, I'd like to make it clear that I'm not here to provide medical advice. Rather, I'll be sharing my interpretation of the guidelines with fellow healthcare professionals. Please always use your clinical judgement when treating your patients.If you prefer a video ...
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    19 min
  • Diabetes guidelines in Practice-clinical case 2

    Diabetes guidelines in Practice-clinical case 2
    Mar 18 2023
    My name is Fernando Florido and I am a GP in the United Kingdom. In today’s episode I look at a new random case to see how the guidelines could apply to it. By way of disclaimer, I am not giving medical advice; this video is intended for health care professionals and remember that guidelines are there to be interpreted and applied using your clinical judgement. What I am doing here is sharing with you what my interpretation would be in this case. It does not mean that it is the only way, or indeed the best way to treat any individual patient. There is a YouTube version of this and other videos that you can access here:·      The NICE GP YouTube Channel: NICE GP - YouTubeThis podcast also appears in: Primary Care guidelines podcast: ·      Redcircle: https://redcircle.com/shows/primary-care-guidelines·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148Prescribing information links: ·      Website: DPP-4 inhibitors | Prescribing information | Diabetes - type 2 | CKS | NICE or·      Download PDF: DPP-4 inhibitors- Prescribing information- Diabetes- type 2- NICE.pdf·      Website: GLP-1 receptor agonists | Prescribing information | Diabetes - type 2 | CKS | NICE or·      Download PDF: GLP-1 receptor agonists- Prescribing information- Diabetes- type 2- NICE.pdf Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through TranscriptHello everyone and welcome. My name is Fernando Florido and I am a GP in the United Kingdom. In today’s episode I look at a new random diabetic case to see how the guidelines could apply to it. By way of disclaimer, I am not giving medical advice; see the description for full information about this:·     NOT medical advice·     Intended for health care professionals·     Only my interpretation of the guideline·     Use your clinical judgement And as you know, we are focusing only on the pharmacological treatment. Remember that there is also a podcast version of these videos so have a look in the description below. Remember that there is also a Youtube version of these episodes so have a look in the episode description.Right, so let’s generate our random patient. So, we have 45-year-old woman with poorly controlled T2DM with an HbA1c of 60 mmols/mol/7.6%, who has CKD stage 3a with an eGFR of 45 and who is also at high risk of CVD. She is also on triple therapy with Metformin 500 mg BD, Dapagliflozin 10 mg OD and Saxagliptin 2.5mg OD. And finally, she is severely obese with a BMI of 43So, let’s have a look at the guidelines. As usual I will focus on the NICE guidelines but at the end I will tell you what my interpretation would have been following the EASD / ADA consensus guideline.Firstly NICE says that we need to consider if rescue therapy is necessary for symptomatic hyperglycaemia with insulin or a sulfonylurea.And for the clinical presentation we will say that she has no symptoms of diabetes, her obesity is long-standing and being managed with diet, lifestyle advice and bariatric referral. We have excluded other causes of Obesity e.g. hypothyroidism or Cushing’s disease and, because of her age, other causes of CKD such as glomerulonephritis or obstructive nephropathy have also been excluded and she has the diagnosis of diabetic nephropathy.Right, so what are my thoughts? Firstly, that she is relatively young and she already has a degree of diabetic nephropathy. So we should manage her fairly aggressively to try and improve her diabetic control and improve long term outcomes.Secondly, it seems quite clear that her main problem is her weight. She is severely obese and already being managed for that. I am very pleased to see that she is not on any medication that promotes weight gain. Both metformin and SGLT2 inhibitors promote weight loss and DPP4 inhibitors are weight neutral. So Dr Spinning Wheel has done very well indeed.The first step is always metformin which would be helpful for her weight too. So I would be interested to see why she is only on 500mg BD instead of the full dose, double that, 1000mg BD.I would first look if it has been kept at that dose because of safety reasons, for example because of her renal function. You can prescribe metformin 1000 mg BD to anyone with an eGFR of 45 or above. Her eGFR is exactly that, 45. Because of being right on the limit, I would want to be sure and I would look back and see what her previous renal function tests have been. If previously the eGFR has been bumping along the high 40s or 50s that I would definitely increase the dose because the drop to 45 could be just a temporary “blip”, although, of course, we would watch her renal function closely. If on the other hand...
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    11 min
  • Diabetes guidelines in Practice-case 1

    Diabetes guidelines in Practice-case 1
    Mar 7 2023
    My name is Fernando Florido and I am a GP in the United Kingdom. With this episode I am starting a new series on Diabetes Guidelines in Practice, looking at how the guidelines could apply to randomly selected clinical cases. By way of disclaimer, remember that guidelines are there to be interpreted and applied using your clinical judgement. What I am doing here is sharing with you what my interpretation would be in this case. It does not mean that it is the only way, or indeed the best way to treat any individual patient. This episode also appears in the Primary Care guidelines podcast: ·      Redcircle: https://redcircle.com/shows/primary-care-guidelines·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here: ·      The NICE GP YouTube Channel: NICE GP - YouTube Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]Music provided by Audio Library PlusWatch: https://youtu.be/aBGk6aJM3IUFree Download / Stream: https://alplus.io/halfway-through TranscriptHello everyone and welcome. My name is Fernando Florido and I am a GP in the United Kingdom.With today’s episode I am starting a new series on Diabetes Guidelines in Practice, looking at how the guidelines could apply to randomly selected clinical cases. By way of disclaimer, remember that guidelines are there to be interpreted and applied using your clinical judgement. I am not giving medical advice here and what I am only doing is sharing with you what my interpretation of the guideline would be in this case. It does not mean that it is the only way, or indeed the best way to treat any individual patient. So, you must always apply your clinical judgement at all times. I will also say that I will only focus on the pharmacological treatment of type 2 diabetes. By all means, we will need to advise about diet, exercise, lifestyle etc, but this will not be addressed in these episodes.Remember that there is also a podcast version of these videos so have a look in the description below.Remember that there is also a Youtube version of these episodes so have a look in the episode description.Right, so let’s get started and let’s generate our random patient. For that we are going to spin a random wheel: Right, so we have an 85-year-old man, newly diagnosed with type 2 diabetes who is poorly controlled with an HbA1c of 65 mmols or 8.1%, who also has heart failure and CKD stage 3b with an eGFR of 32. In addition, he is underweight, even possibly malnourished to some degree. Right, we are going to look at the guidelines and how to apply them. Although I will focus on the NICE guideline, in this case my interpretation and the outcome would be exactly the same if you follow the EASD recommendations or the ADA guideline.So, what does NICE say that we should do? Firstly, we need to consider if rescue therapy is necessary because, for symptomatic hyperglycaemia, we will need to consider insulin or a sulfonylurea and review when blood glucose control has been achieved. So, we are going to assume that he is well and that he has no symptoms of diabetes. He is underweight, but this has been like this for a few years. There hasn’t been rapid weight loss indicating an urgent need for insulin and his urinary ketones are negative. Other causes of unintentional weight loss such as cancer have also been excluded.So, we are just focusing on the diabetes. His HbA1c is high and has not improved with diet and lifestyle advice, so we should do something. However, given his age, we are not going to manage him too aggressively because, at 85, we are probably more concerned about harmful hypoglycaemia. But he does need treatment and certain diabetic agents could also help his co-morbidities. So, next, we must look at his medical history. He has both CKD and heart failure and we know that SGLT2 inhibitors can be beneficial for both these conditions.However, because of the benefits of metformin, NICE says that first, we should consider starting metformin alone to assess tolerability and once this has been confirmed, we could add an SGLT2 inhibitor.Arguments against using metformin at all in this patient are that his eGFR is fairly low and at 32 he is quite close to CKD stage 4.Also, because he is underweight with possible low muscle mass, we need to remember how the estimated GFR is calculated and consider that, as a result of the low muscle mass, his eGFR may be overestimated and that his actual GFR could be below 30. We know that we can use metformin quite normally if the eGFR is above 45, we need to review the dose and prescribe it cautiously if the eGFR is between 30 and 45 and then stop it completely when the eGFR falls below 30.The manufacturer of metformin also advises caution in chronic stable heart failure with the...
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    8 min
  • Cardiovascular health and diabetes

    Cardiovascular health and diabetes
    Oct 30 2022
    My name is Fernando Florido and I am a GP in the United Kingdom. In this podcast I I give my summary of the online course by the EASD learning website “Cardiovascular health and diabetes”.This podcast will be saved on a website. There is also a YouTube video on this subject and other NICE guidance. You can access the channel here:https://www.youtube.com/channel/UClrwFDI15W5uH3uRGuzoovw The online course can be found on the EASD learning website:https://easd-elearning.org/courses/cardiovascular-health-and-diabetes/ Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]Music provided by Audio Library PlusWatch: https://youtu.be/aBGk6aJM3IUFree Download / Stream: https://alplus.io/halfway-throughTranscriptHello everyone and welcome to the channel. My name is Fernando Florido and I am a GP in the United Kingdom. Today we are going to talk about the link between cardiovascular health and diabetes. The information that I am going to give is based on an online course that is available on the EASD learning website. I highly recommend it and I will put the link to access this course in the episode description. It has seven modules and it is likely to take you between 5 and 7 hours to complete it, depending on how quickly you can process the information. Today’s episode is a summary of the course, which I hope that you will find useful. As ever, remember that there is a YouTube version of this episode and the link to the YouTube channel is also in the episode description.People with type 2 diabetes have twice as many coronary heart disease and strokes as those without it. At first glance, you could think it was too much, but in reality, this is a significant improvement. Previous data indicated that the risk of cardiovascular disease increased by around four to six times. Thus, doubling the risk indicates a significant improvement. Blood pressure control and strict cholesterol treatment are now standard management. And as a result, there are far fewer atherosclerotic events that affect persons with type 2 diabetes. However, as a result, heart failure is now becoming more common.According to research, people with type 1 diabetes have steadily experienced a decline in CVD, CV mortality, and CV hospitalisation. However, there is still a significant gap between those who have type 1 diabetes and those who do not.The same research, however, revealed that those with type 2 diabetes had experienced a far bigger improvement, resulting in, at worst, a doubling of the risk of cardiovascular disease (CVD), hospitalisation for CVD, and cardiovascular mortality. And once more, this has been associated with intensive blood pressure and cholesterol management; perhaps this is something that might be applied to patients with type 1 diabetes, where the focus is still often on glycaemia-related issues.According to other studies, people with type 2 diabetes have an increased chance of developing heart failure. This increased risk is most noticeable in the middle-aged group, perhaps those up to the age of 55, and it appears to be less of an issue as people get older. Therefore, heart failure is now one of the most significant CVD symptoms in persons with type 2 diabetes.Atherosclerotic disease, coronary heart disease, or strokes are still the earliest signs of vascular illness in the non-diabetic population. However, peripheral vascular disease or heart failure are the most typical early presentations of vascular disease in persons with type 2 diabetes.Heart failure in diabetics is caused by a number of different ways. First, excess atherosclerotic disease. Also, the heart's ability to operate can then be impacted by hypertension itself. Additionally, a lot of our patients are now recovering from myocardial infarctions, and as time passes, the ventricle develops scarring that exacerbates heart failure. Furthermore, apart from atherosclerosis and hypertension, there is a heart condition known as "diabetic cardiomyopathy" that damages the myocardium. The ventricle becomes extremely stiff due to a combination of metabolic and pathological causes, making it difficult for the ventricle to relax and fill. And finally, diabetic autonomic neuropathy also plays a role in the development of heart disease in patients with diabetes.Variations in glycaemic control and chronic hyperglycaemia are recognised epidemiologically as risk factors for cardiovascular disease in people with diabetes.There are now numerous things we can do for our patients with diabetes to lower cardiovascular risk, just as there are numerous risk factors for heart disease in those with diabetes. One factor we take into account is lifestyle, but studies have shown that this is a pretty unsatisfactory intervention when we focus on heart disease, frequently failing to show any benefit on lowering cardiovascular disease rates. However, we continue to believe that lifestyle intervention is crucial for some people.After bariatric ...
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    21 min
  • EASD ADA consensus guidelines on type 2 diabetes

    EASD ADA consensus guidelines on type 2 diabetes
    Sep 10 2022
    Episode: EASD ADA consensus guidelines on the overall approach in glucose lowering medication in type 2 diabetes This podcast is intended for healthcare professionals. My name is Fernando Florido and I am a GP in the United Kingdom. In this episode I go through the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus guidelines on the overall approach in glucose lowering medication in type 2 diabetes. I will firstly give you a list of the changes to the previous consensus recommendations followed by a description of the consensus recommendations flowchart on the subject. The original article was published on 19 December 2019 with a subsequent correction published on 15 May 2020.There is a YouTube version of this episode in the NICE GP YouTube Channel that you can access here: ·      https://www.youtube.com/channel/UClrwFDI15W5uH3uRGuzoovw This episode also appears in the  Primary Care guidelines podcast:  ·      Redcircle: https://redcircle.com/shows/primary-care-guidelines·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 Diabetes in Primary Care podcast: ·      Redcircle: https://redcircle.com/shows/diabetes-in-primary-care·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK·      Apple podcasts: https://podcasts.apple.com/us/podcast/diabetes-in-primary-care/id1562910252 The ADA-EASD consensus guidelines can be found here:  ·      Website: o  https://link.springer.com/article/10.1007/s00125-019-05039-w ·      Or download here: o  https://1drv.ms/b/s!AiVFJ_Uoigq0lW-4rilnP_mruV41?e=FjPLGo The Summary of the changes to the previous consensus recommendations can be·      Viewed on website above:o  https://link.springer.com/article/10.1007/s00125-019-05039-w·      Or downloaded here:o  https://1drv.ms/b/s!AiVFJ_Uoigq0lW72FZuzZZiv8bPr?e=7Fib8M The Visual summary “glucose lowering medication in type 2 diabetes- overall approach” can be found here:·      Website: o  Figure 1 | 2019 update to: Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) | SpringerLink ·      Or download here: o  https://1drv.ms/u/s!AiVFJ_Uoigq0lXCNFscGYei60BiV?e=3n0ErnIntro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] Music provided by Audio Library Plus Watch: https://youtu.be/aBGk6aJM3IU Free Download / Stream: https://alplus.io/halfway-through Transcript:This podcast is intended for healthcare professionals. Thank you for listening and welcome to a new episode, bringing you medical information and clinical guidance from a primary care perspective. My name is Fernando Florido and I am a GP in the United Kingdom.In today’s episode I am going to go through the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus guidelines on the overall approach in glucose lowering medication in type 2 diabetes.I will firstly give you a list of the changes to the previous recommendations followed by a description of the consensus recommendations flow chart.If you have been following previous episodes, you may be familiar with the updated NICE guidelines on the management of type 2 diabetes. However, the NICE recommendations, primarily followed in the UK, have some substantial differences when compared to other international recommendations and this is why I have decided to do this episode today. You will notice that the main difference with NICE refers to the use of GLP1 mimetics which NICE considers to be less cost effective. However, from a clinical perspective, there is now ample evidence in their favour, which justifies a wider use as described in the consensus guidelines.I will put in the description below a link to download the full article as well as the summary of the changes and the flow chart. There is a YouTube version of this episode and other NICE guidance on the NICE GP YouTube Channel and a link to access it can be found in the podcast description. Because of the visual nature of the flow chart, I would highly recommend watching the YouTube video if you can.Although describing visual aids as audio files can be challenging, I hope that you find the content clear and informative. Right, let’s go right in. So, we are going to start looking at the European Association for the Study of Diabetes and the American Diabetes Association consensus guidelines on managing hyperglycemia in type 2 diabetes, published in December 2019, corrected in May 2020 and I have put links in to it in the episode description.Now, before starting the treatment flow chart, we are going to go through the changes to the consensus recommendations ...
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    18 min
  • 2022 NICE diabetes treatment flowcharts

    2022 NICE diabetes treatment flowcharts
    Aug 28 2022
    My name is Fernando Florido and I am a GP in the United Kingdom. In this video I go through the Visual summary “choosing medicines for first-line and further treatment” corresponding to the 2022 updated NICE Guideline: Type 2 diabetes in adults: management (NG28 guideline), updated on 29th June 2022. The video focuses on the drug treatment recommendations in blood glucose management in adults with Type 2 Diabetes.This podcast will be saved on a website.There is also a YouTube video on this subject and other NICE guidance. You can access the channel here:https://www.youtube.com/channel/UClrwFDI15W5uH3uRGuzoovwThis podcast also appears in the Primary Care Guidelines podcast which can be found here:·      Redcircle: https://redcircle.com/shows/primary-care-guidelines·      Spotify: https://feeds.redcircle.com/2587ad78-7730-48f6-894e-f1f4178e37c3·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148NICE Guideline NG28 can be found here:https://www.nice.org.uk/guidance/ng28  The full NG28 full guideline PDF document can be found here:·      Website:https://www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-pdf-1837338615493·      If outside the UK, you can download it here: https://1drv.ms/b/s!AiVFJ_Uoigq0lWqK_tYk1rnOolRO The visual summary “choosing medicines for first-line and further treatment” can be found here:·      Website:https://www.nice.org.uk/guidance/ng28/resources/visual-summary-full-version-choosing-medicines-for-firstline-and-further-treatment-pdf-10956472093·      If outside the UK, you can download it here: https://1drv.ms/b/s!AiVFJ_Uoigq0lWugUmhgaYv1PHyf Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]Music provided by Audio Library PlusWatch: https://youtu.be/aBGk6aJM3IUFree Download / Stream: https://alplus.io/halfway-throughTranscriptThank you for listening and welcome to a new episode of this podcast bringing medical information and NICE guidance from a primary care perspective. My name is Fernando Florido and I am a GP in the United Kingdom.Now, imagine that we have Mr. Johnson, who is 78 and has type 2 diabetes. His diabetes control is reasonable or metformin, 500mg BD. With an HbA1c of 7.1% or 54 mmol/mol, but he has just developed stable angina. How should his diabetic treatment change? We have covered the 2022 NICE diabetes management update in previous episodes, but perhaps we need a quick reminder?And this is what we’re going to do today because in this video I am going to go through the flow charts produced by NICE in respect of the blood glucose management in type 2 diabetes. The full guideline has 59 pages in a PDF format and NICE has produced a 5-page summary on the blood glucose management. This video is going to focus on the two flow charts that will advise how to choose first line medicines and how to choose medicines for further treatment.I will put in the description below a link to download the full NICE guideline as well as the five-page summary. There is a YouTube version of this episode and other NICE guidance on the NICE GP YouTube Channel and a link to access it can be found in the podcast description. Because of the visual nature of the flow chart, I would highly recommend watching the YouTube video if you can.Although describing visual aids as audio files can be challenging, I hope that you find the content clear and informative.Now the first flow chart that we are going to look at is the one about how to choose first line medicines. It is only one page and there is a combination of arrows that will guide us through the treatment pathways and a number of boxes with further information and clarification on the treatments described.Right at the top of the chart, we find a box that tells us about rescue therapy and it reminds us that for patients with symptomatic hyperglycaemia, we will consider insulin or a sulphonylurea and then review the treatment when their blood glucose control has been achieved.Then the next step is to assess the HbA1c, the cardiovascular risk and kidney function. Obviously, as you know, to calculate the cardio vascular risk with, for example, the QRISK2 tool, we will need to know the patient’s age, sex, smoking status, blood pressure and the total cholesterol/HDL ratio.Now, having checked the renal function, before starting to follow the pathway, there is a little box on the left telling us that for information on using SGLT 2 inhibitors for people with type 2 diabetes and CKD, there is specific guidance that is not on this flow chart and we will have to refer to CKD section of the diabetic guideline.So, after we have done our initial assessment with the HbA1c, cardiovascular risk and kidney function, the flow chart divides into three categories. One, it could be that the patient is not at high cardiovascular risk. Two, that the patient has chronic heart failure or ...
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    14 min
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