Published: 22 January, 2021
New national type 2 diabetes management guidance published
The New Zealand Society for the Study of Diabetes and the Ministry of Health have published
new guidance on the management of type 2 diabetes in adults. This guidance provides information on screening and
diagnosis, glycaemic monitoring and targets, non-pharmacological and pharmacological treatments (including the place
of the newly
funded diabetes medicines), management of diabetes complications, hypoglycaemia, diabetes in pregnancy and pre-diabetes.
bpacnz will be publishing an updated article on diabetes management, highlighting the main changes in
practice, including use of SGLT-2 inhibitors and GLP-1 agonists.
Pre-COVID-19 Special Authority criteria to be reinstated from 1 February, 2021
has advised that temporary changes made to Special Authority funding criteria in response to the COVID-19 pandemic
will no longer apply from 1 February, 2021 and original funding criteria will be reinstated. This will only affect
new Special Authority applications. Any active Special Authority approvals will continue; people with current approvals
will only be affected if or when Special Authority renewal is required.
N.B. Prior to this announcement, a small number of temporary funding changes were made permanent and therefore will
continue for these medicines; click
here for more information.
Supply update for oral contraceptives Norimin and Brevinor 1/28
Norimin (ethinyloestradiol 35 micrograms with norethisterone 500 micrograms) is now back
in stock with the supplier and is being released to wholesalers. Norimin will be available once the stock of Necon,
an alternative brand listed to cover the out-of-stock period, has been used.
Brevinor-1 28 (ethinylestradiol 35 micrograms + norethisterone 1 mg) is also now back
in stock with the supplier and being released to wholesalers. No equivalent alternative brand was available to
replace Brevinor-1 28, therefore people who were taking it were switched to a different contraceptive. Patients switching
back to Brevinor-1 28 will need to follow the seven-day rule to maintain effective contraception
due to possible bioequivalence differences, i.e. use an additional contraception method until seven consecutive hormone
pills have been taken.
Moclobemide (Aurorix) 300 mg tablets: stocks are running low
A manufacturing issue has
affected supplies of moclobemide (Aurorix) 300 mg tablets; 150 mg tablets are unaffected. It is expected that
supply will be restored by the end of April, 2021. Pharmacists can dispense two 150 mg tablets instead of one 300
mg tablet, and PHARMAC is confident that there is enough stock to cover the increased demand for 150 mg tablets.
NZF updates in January release
New sections added to the NZF in January, 2021, include:
- Urinary tract infection - includes guidance on antibiotic
choice for cystitis, recurrent cystitis, pyelonephritis and acute and chronic prostatitis
- COVID-19 vaccines - includes links to relevant organisations
involved in preparing the COVID-19 immunisation programme
Other updates include:
- New indications added for several antibiotics, e.g. if antibiotics are required for diverticulitis, additional
options are now indicated; contraindications, dosing in renal impairment and pregnancy advice updated for nitrofurantoin
- New indication added for dexamethasone – treatment of coronavirus disease 2019 (COVID-19) in patients who require supplemental oxygen therapy
- Caution added for progesterone – Utrogestan capsules are contraindicated for people with hypersensitivity to peanut
or soya as they contain soya lecithin as an excipient
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Paper of the week: Are low carbohydrate diets effective and safe
for type 2 diabetes remission?
People with type 2 diabetes who are overweight can achieve a non-diabetic state if they are able to lose enough body
weight. A new analysis published in the BMJ assesses the effectiveness and safety of low carbohydrate diets (<130 g/day
or <26% of a 2000 kcal/day diet) and very low carbohydrate diets (<10% calories from carbohydrates) undertaken for
at least 12 weeks in adults with type 2 diabetes. Measured outcomes included type 2 diabetes remission, weight loss,
HbA1c, fasting glucose and adverse events. Low carbohydrate diets were associated with a 32% increase in diabetes remission
at six months compared with control (mostly low fat) diets. However, in the long term, low carbohydrate diets are associated
with increased all-cause mortality, therefore the study authors recommend that clinicians consider short-term low carbohydrate
diets for the management of patients with type 2 diabetes.
- Low carbohydrate diets were associated with a 32% increase in remission of diabetes at six months compared
with control (mainly low fat) diets (moderate certainty evidence)
- Low carbohydrate diets were associated with increased weight loss, reduced diabetes medicine use, improved
triglyceride levels and insulin sensitivity at six months. These benefits decreased at 12 months.
- Very low carbohydrate diets were less effective than low carbohydrate diets for weight loss, likely due to
- No significant or clinically important negative effects on cardiovascular risk factors (e.g. lipids, C-reactive
protein) or adverse effects were found with low carbohydrate diets. There was a trend toward an increase in low
density lipoprotein cholesterol levels and worsening quality of life at 12 months.
- Remission rates were lower in studies that included patients using insulin
Read the full paper here
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