My name is Fernando Florido and I am a General Practitioner in the United Kingdom. Welcome to the latest instalment in our monthly video series, "NICE News," where we discuss new and updated guidelines published by the National Institute for Health and Care Excellence (NICE), specifically as it relates to primary care.
In this video, I'll be focusing on the NICE guidance and advice published in July 2023. We'll be reviewing the latest recommendations that are relevant to primary care practitioners, with the goal of keeping you informed and up-to-date on the latest developments.
Please note, 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:
The link to the PDF version of this video can be downloaded here:
· Printable version: https://1drv.ms/b/s!AiVFJ_Uoigq0l2tnS9ulRaEBT8Af?e=TCk7ZO
· Colour & photo version: https://1drv.ms/b/s!AiVFJ_Uoigq0l2w1zRoLSYM34HhO?e=avMoqf
The links to the update guidance covered can be found here:
Obesity in adults: identification, assessment and management
· https://www.nice.org.uk/guidance/cg189
KardiaMobile for detecting atrial fibrillation
· https://www.nice.org.uk/guidance/mtg64
Semaglutide for managing overweight and obesity in young people aged 12 to 17 years (terminated appraisal)
· https://www.nice.org.uk/guidance/ta910
Alcohol-use disorders: diagnosis and management:
· https://www.nice.org.uk/guidance/qs11
Draft consultation: Vitamin B12 deficiency in over 16s: diagnosis 6 and management
· Document:https://www.nice.org.uk/guidance/GID-NG10176/documents/draft-guideline
· Consultation on draft guideline is open until 5pm on Tuesday 22 August 2023: https://www.nice.org.uk/guidance/indevelopment/gid-ng10176/consultation/html-content
Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]
Transcript
Hello and welcome to another episode of NICE News. My name is Fernando Florido, a GP in the United Kingdom. Today, we'll be discussing the NICE Guidance and advice published in July 2023, specifically for Primary Care.
This month we are focusing on obesity, atrial fibrillation and alcohol misuse. If you want to download a PDF version of this episode, the link is in the episode description.
Before we begin, I want to remind you that this episode is not medical advice. It is only my interpretation, and you must use your clinical judgement.
I'd like to remind you that there is a YouTube version of this episode which can be found in the episode description.
Now, with that said, let’s get straight into it.
The first clinical area refers to the guideline on obesity.
We will refer for bariatric surgery if they:
· have a BMI of 40 or more, or over 35 with a significant health condition that could be improved if they lost weight
· The BMI threshold is reduced by 2.5 for South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background to account for the fact that these groups are prone to central adiposity with cardiometabolic risks at a lower BMI.
And in terms of Pharmacological interventions, NICE has not recommended naltrexone–bupropion but there is a list of three approved medicines for obesity. Liraglutide and semaglutide can only be prescribed for obesity by secondary care and orlistat, which can also be prescribed in primary care. The prescribing criteria are:
· Liraglutide: BMI of 35 or 32.5 for members of minority ethnic groups
and
Non-diabetic hyperglycaemia (HbA1c level of 42 - 47 mmol/mol [6.0% to 6.4%] or a fasting plasma glucose level of 5.5 - 6.9 mmol/litre)
and
High risk of CVD
· Semaglutide: BMI of 35.0 or 30.0 if they meet certain referral criteria but reduce BMI thresholds by 2.5 for people from Asian, Chinese, Middle Eastern, Black African or African-Caribbean family backgrounds
and
At least 1 weight-related comorbidity
And we will consider stopping if less than 5% of the initial weight has been lost after 6 months. We will use it for a maximum of 2 years
· Orlistat: BMI of 30 or more or 28 or more with associated risk factors. It should not be used with other drugs aimed at weight reduction and we should continue beyond 3 months only if the person has lost at least 5% of their initial body weight. However, rates of weight loss may be slower in people with type 2 diabetes, so less strict goals may apply to theml
As a separate guidance NICE is unable to make a recommendation on semaglutide for managing overweight and obesity in people aged 12 to 17 years because the manufacturer considers that, at this time, there is not enough evidence to support it for this population.
The next topic is KardiaMobile for detecting atrial fibrillation
This guidance had been withdrawn because of technical issues but it has now been re-introduced. Therefore KardiaMobile is recommended for detecting atrial fibrillation (AF) for people with suspected paroxysmal AF, who are referred for ambulatory electrocardiogram (ECG). KardiaMobile is a portable ECG recorder and Clinical evidence shows that significantly more people had AF detected using the KardiaMobile single-lead device compared with a Holter monitor. Furthermore, cost modelling shows that KardiaMobile is cost effective.
In terms of alcohol-use disorders there are 5 new quality statements focusing on key areas. The two areas relevant to primary care are that:
1. Adults who are being asked about their alcohol use have a validated alcohol questionnaire completed to identify any need for a brief intervention or referral to specialist alcohol services.
2. Adults seeking help are given information on community support networks and self-help groups.
I will also mention that there is a first-ever NICE guideline on vitamin B12 deficiency, which at the moment is only in draft form. It basically says that older people with unexplained fatigue or mental health problems should be offered a vitamin B12 test. The draft publication offers recommendations on how to diagnose it and treat it. I will not say much more because, being in draft, it is likely to change, but it is something that we can look forward to in the near future. If you want to see the draft document or take part in their consultation, I have put the link to it in the episode description.
And lastly, we will end with the sad news that NICE is to stop supplying print copies of the BNF. The guidance will now only be in a digital format, either online or as a mobile app, so if you have one of the printed copies of the BNF lying around, look after it because, given enough time, it may eventually become an important historic item.
We have come to the end of this episode. I hope that you have found it useful. Thank you for listening and good-bye
