Published: 16 April, 2021
What’s coming up: diabetes special edition
We are currently in the process of producing a special edition eJournal focused on type 2 diabetes.
In this issue we will take a closer look at key aspects
of diabetes management in primary care. Featured articles include:
- Type 2 diabetes management toolbox: from metformin to insulin – an overview of the range of available pharmacological
treatments for diabetes
- Prescribing empagliflozin and dulaglutide – a closer look at the newly funded medicines, who is eligible for funded
treatment and any monitoring requirements and other key prescribing information. N.B. this article has been published
in advance in the latest edition of eBPJ
- Prescribing vildagliptin – a focus on the recommended second-line treatment for people not eligible for funded
empagliflozin or dulaglutide
- Initiating insulin for people with type 2 diabetes – covering what regimen of insulin to choose, what you need
to monitor and other key practice points
- The annual diabetes review - screening, monitoring and managing complications, including retinopathy, neuropathy,
hypertension and diabetic kidney disease
- A rising tide of type 2 diabetes in younger people: what can primary care do? – a focus piece on detecting diabetes
in children, adolescents and younger adults, including the inequitable impact of diabetes on Māori and Pacific peoples
- Lifestyle interventions in type 2 diabetes – the role of diet, weight loss and exercise
Let us know if there are any particular clinical questions or other primary care practice issues you would like us to cover.
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The 2021 "Flu Handbook" is now available
The Immunisation Advisory Centre has released the "Everything you need to know about FLU 2021" handbook, available
The handbook includes key reference information about vaccine eligibility, delivery, storage and administration, clinical information
about the vaccines and vaccination in special groups.
The www.fightflu.co.nz website intended for the general public has also been revamped and new resources added.
Reports on adverse events associated with COVID-19 vaccination
Medsafe is now publishing weekly safety
monitoring reports associated with COVID-19 vaccination. The
first safety report published from data
collected up to 6 March, 2021, recorded 147 new adverse effects following immunisation, including three serious allergic reactions. Dizziness,
headache, nausea and syncope are the most frequently reported adverse events. Subsequent reports add to this data.
Making an adverse reaction report
N.B. Medsafe also publishes an annual
influenza vaccine adverse events report.
Widened access to funded treatments for multiple sclerosis
As of 1 March, 2021, access
to funded treatments for multiple sclerosis (MS) has widened . Calculation of an Expanded Disability Status Scale (EDSS)
score is a requirement for Special Authority approval; the broadened range for this score means that some people with MS may continue on funded treatment
for longer and in some cases those who have stopped funded treatments may now be eligible to restart. The Special Authority process has been simplified,
with one form now used for all MS medicines, and once approved, patients can change between different funded medicines if needed. Make sure your patients
with multiple sclerosis are aware that they may be eligible for treatment and to discuss this with their specialist – in some cases general practitioners
will have delegated authority for prescribing MS medicines.
Further information on what’s changed is
Biologic treatment for psoriatic arthritis and ankylosing spondylitis
From 1 May, 2021, funded access to the biologic secukinumab
will be widened
for people with psoriatic arthritis
and ankylosing spondylitis. Currently, secukinumab is only funded with Special Authority approval as a first- and second-line
biologic for people with severe chronic plaque psoriasis (available in a 2-syringe pack; each 150mg/mL)*. The change
in funding and access means secukinumab will now also be available as:
- A funded first or second-line biologic for psoriatic arthritis (with Special Authority)
- A funded second-line biologic for ankylosing spondylitis, after trialling adalimumab or etanercept (with Special
- A singular syringe pack**
N.B. All other existing Special Authority criteria for secukinumab will stay the same.
*Prior to the 1 May 2021 funding revision, secukinumab was previously indicated for psoriatic arthritis and ankylosing
spondylitis but funded only with Special Authority for severe chronic plaque psoriasis
**Secukinumab will continue to be available in a 2-syringe pack
Interactive data on problem gambling
Problem gambling has become a significant public health concern for New Zealand. Harmful gambling affects not
only the gambler themselves but has the potential to significantly impact the financial, health and social wellbeing
of family/whānau and the wider community. Harmful gambling disproportionately affects certain population groups.
The Gambling Data Explorer is an interactive
tool that uses the data from
the National Gambling Study (NGS)* to selectively compare the impact of demographic variables on gambling behaviour
in New Zealand adults. Variables include age, gender, ethnicity, income, labour force status and household size.
Currently, only the data from 2012 is available, however the NGS anticipates more data from 2013-2015 to become available in the future.
*The NGS longitudinal study (2012-2015), examined the gambling habits of 6,251 New Zealand adults, aged 18 years
and older. Participants were interviewed and re-interviewed each year from 2012 to 2015, exploring their gambling habits,
lifestyle, health and attitudes towards gambling.
Click here for
more information on the NGS data explorer.
Paper of the week: Public perspective on low back pain
Low back pain is a significant and debilitating health issue with relatively few effective treatment interventions. How people with back pain feel about their
condition, their perceptions, misconceptions and ability to cope, has a direct effect on the magnitude of treatment success and likelihood of return to normal
daily activities. A Canadian study based on a population survey found that overall people perceive back pain to have inevitable negative consequences. Around
half of respondents believed that experiencing an episode of back pain means that you will always have weakness in your back, the pain will progressively worsen,
resting is beneficial and having x-rays or scans is necessary for management.
The results of this study, which are consistent with similar studies from other countries, suggest that influencing beliefs, misconceptions and attitudes
about back pain is an essential component of successful management and achieving optimal health outcomes for the patient. Clinicians can provide evidence-based
education to people with low back pain, e.g. on the importance of engaging in physical activity and avoiding rest, on the minimal efficacy of pain medicines
and the appropriate role of investigations.
- The study included 428 participants (from 3000 surveys), with an average age of 55 years, 66% female and 90%
reported a history of low back pain (89% in the past year and 74% in the past week)
- Half (50%) took analgesics for their back pain, 46% rested or avoided activity, 15% lay down, 52% sought
medical/professional treatment; the majority of whom (72%) saw a general practitioner
- Of the people who sought medical/professional treatment 52% were advised to take analgesics, 49% were advised
to stay active, 30% were advised to rest
- The mean score on the Back Beliefs Questionnaire (27.3) indicated that most people perceive back pain to have
unavoidable negative consequences
- A large proportion of participants held beliefs that are contrary to current evidence-based guidance:
- Experiencing low back pain means you will always have weakness in your back (49%)
- Pain will become progressively worse (48%)
- Back pain must be rested (41%)
- Simple painkillers are not enough to control most back pain (48%)
- X-ray or scans are necessary to receive the best care (54%)
The implications of these findings are that many people with back pain believe that they should stop working and rest and that their back
will always be weak. Primary care health professionals should focus on educating patients on the causes and evidence-based treatment
of back pain to help them to understand how best to manage their pain and stay active for a more rapid recovery.
Read the full paper here
Hall A, Coombs D, Richmond H, et el. What do the general public believe about the causes, prognosis and
best management strategies for low back pain? A cross-sectional study. BMC Public Health, 2021;21(682).
Related reading: Helping patients cope with chronic non-malignant pain: it's not about the opioids. bpacnz, 2014.
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