Diabetes (type 2) - glitazones (review)

Summary

The recommendations in this technology appraisal have been replaced by recommendations in the type 2 diabetes clinical guideline published in May 2008 (see http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11635). Therefore this guidance is obsolete.

NICE has recommended the use of a glitazone, in combination with either metformin or a sulphonylurea, only for those people with type 2 diabetes for whom monotherapy hasn?t worked to control glucose levels and who cannot take metformin and a sulphonylurea together because they cannot take one of these drugs ? either because there is a reason why it is not suitable for them or because they cannot tolerate its side effects. In this situation, the glitazone can be used to replace either of these drugs in combination therapy.

The effectiveness of treatment with a glitazone and metformin or a sulphonylurea should be monitored by checks on blood glucose levels and other tests, including the levels of different fats (lipids) in the blood. (Diabetes can affect the levels of lipids such as cholesterol in the blood, which can increase the risk of problems with the heart and blood vessels.)

Because of the terms of the current licences for the use of glitazones, NICE cannot recommend the use of glitazones alone, as triple combination therapy (that is, with two other oral glucose-lowering drugs), or in combination with insulin.

These recommendations are different from those that NICE issued in 2000 and 2001. The current guidance does not recommend the use of a glitazone in combination with either metformin or a sulphonylurea for people who can take and tolerate the metformin?sulphonylurea combination treatment but have found it does not adequately control their blood glucose levels.

This guidance replaces Diabetes (type 2) - rosiglitazone (No. 9) and Diabetes (type 2) - pioglitazone (No. 21).

Documents

For healthcare professionals

• TA63 Diabetes (type 2) - glitazones (review): Summary
• TA63 Diabetes (type 2) - glitazones (review): Guidance

For patients, carers and the public

• TA63 Diabetes (type 2) - glitazones (review): Information for the public

Background information

• Review decision
• Review proposal
• 2003/038 NICE updates guidance on glitazones for people with type 2 diabetes in England and Wales
• Assessment Report: The Clinical and Cost-effectiveness of Pioglitazone and Rosiglitazone in the Treatment of type 2 Diabetes

Implementing this guidance

Any further information NICE has produced to help the NHS implement this guideline locally is linked to below:

• None found