8 NEWS
Above and beyond glycaemic control 1 , 2
8 NEWS
6 OCTOBER 2023 ausdoc . com . au
GP banned for punching patient
Heather Saxena A GP who punched a regular patient in the face while accusing him of robbing the practice has been struck off .
The assault occurred in the waiting room as the patient waited for an appointment in October 2020 , the Victorian Civil and Administrative Tribunal heard .
CCTV footage showed the GP entering the waiting room to speak with a different patient .
“[ The GP ] approaches the patient seated … [ and ] delivers one punch whilst the patient remained seated ,” it said .
“[ He ] then backs away a few metres and , with arm outstretched towards the door , demands that the patient leave the clinic .”
The patient , who reported a sore jaw but nothing
PBS Information : JARDIANCE ® : Authority Required ( STREAMLINED ). Type 2 Diabetes . Code 7506 - Add-on to metformin or SU . Code 4991 - Add-on to Insulin . Code 5629 - Triple therapy ( with metformin and SU ). Code 7528 - Triple therapy , initial treatment ( with metformin + DPP4i ). Code 7495 - Triple therapy , continuing treatment ( with metformin + DPP4i ). Refer to PBS Schedule for full Authority Required Information . worse , told police the GP had accused him and his “ crew ” of breaking into the surgery and stealing valuable goods , worth $ 40,000 .
Later , the patient told AHPRA that he had consulted the GP 2-3 times a month for around three years .
The solo GP did not respond to the disciplinary proceedings at all , the tribunal said .
It relied on his statements
BEFORE PRESCRIBING , PLEASE REVIEW THE FULL PRODUCT INFORMATION AVAILABLE FROM BOEHRINGER INGELHEIM AT WWW . BOEHRINGER-INGELHEIM . COM . AU / PI
JARDIANCE ® ( empagliflozin ) 10 mg , 25 mg film-coated tablets . INDICATIONS : Glycaemic control : Treatment of type 2 diabetes mellitus ( T2DM ) to improve glycaemic control in adults as : Monotherapy - When diet and exercise alone do not provide adequate glycaemic control in patients for whom use of metformin is considered inappropriate due to intolerance ; Add-on combination therapy - With other glucose-lowering medicinal products including insulin , when these , together with diet and exercise , do not provide adequate glycaemic control . Prevention of cardiovascular ( CV ) death : In patients with T2DM and established CV disease to reduce the risk of CV death . To prevent CV deaths , Jardiance should be used in conjunction with other measures to reduce CV risk in line with the current standard of care . CONTRAINDICATIONS : Hypersensitivity to empagliflozin or any of the excipients ; for the treatment of T2DM - JARDIANCE should not be used in patients with severe renal impairment ( eGFR < 30mL / min / 1.73m 2 ) as glycaemic efficacy depends on renal function ; rare hereditary conditions of galactose intolerance , e . g . galactosaemia . PRECAUTIONS : Patients with type 1 diabetes ; ketoacidosis ; surgery ; patients with T2DM - contraindicated when eGFR is below 30mL / min / 1.73m 2 ; monitoring of renal function is recommended ; consider discontinuation in patients with recurrent complicated urinary tract infections ( UTIs ); necrotising fasciitis of the perineum ( Fournier ’ s gangrene ); patients for whom a drop in BP could pose a risk ( e . g . those with known CV disease , on diuretics , have a history of hypotension , or aged ≥75 years ); pregnancy ; lactation ; children (< 18 years ). INTERACTIONS : Diuretics - may add to diuretic effect of thiazide and loop diuretics ; insulin and sulfonylurea ( SU ) - may increase the risk of hypoglycaemia ; interference with 1,5-anhydroglucitol assay ; lithium - may decrease blood lithium levels . ADVERSE REACTIONS : Very common : hypoglycaemia ( combination with metformin and an SU ; insulin ). Common : hypoglycaemia ( combination with metformin ; pioglitazone with or without metformin ; metformin and linagliptin ); UTIs ; increased urination ; vaginal moniliasis , vulvovaginitis , balanitis and other genital infections ; volume depletion ( patients aged ≥75 years ); thirst ; pruritis ; serum lipids increased ; constipation . Others , see full PI . DOSAGE AND ADMINISTRATION : JARDIANCE can be taken with or without food . The recommended starting dose is 10mg once daily . For patients tolerating 10mg once daily and require additional glycaemic control , increase dose to 25mg once daily . No dose adjustment is necessary for patients based on age , patients treated for T2DM with eGFR ≥30mL / min / 1.73m 2 or hepatic impairment . When used in combination with an SU or insulin , a lower dose of the SU or insulin may be considered to reduce the risk of hypoglycaemia . September 2022 .
References : 1 . JARDIANCE ® Product Information . 2 . Zinman B et al . N Engl J Med 2015 ; 373:2117 – 28 . 3 . Wanner C et al . N Engl J Med 2016 ; 375:323-34 .
Abbreviations : 3P-MACE = 3-point major adverse cardiac event ; CAD = coronary artery disease ; CI = confidence interval ; CV = cardiovascular ; HHF = hospitalisation for heart failure ; HR = hazard ratio ; MDRD = Modification of Diet in Renal Disease ; MI = myocardial infarction ; PAD = peripheral artery disease ; RRR = relative risk reduction .
Boehringer Ingelheim Pty Limited , ABN 52 000 452 308 78 Waterloo Road , North Ryde , NSW 2113 Australia . Copyright © 2023 . ELI4658 _ ADG _ A4SP4C . PC-AU-103227 . Prepared January 2023 .
In patients with type 2 diabetes and established CV disease ( CAD , PAD , MI or stroke ) on top of standard of care *
THE POWER TO ACCOMPLISH MORE ‡
‡
Above and beyond glycaemic control 1 , 2
Indication
38 % RRR
IN CV DEATH 1 , 2 *
Not actual patient .
HR = 0.62 95 % CI : 0.49 , 0.77 ; p < 0.001 . 1 , 2
35 % RRR
IN HOSPITALISATION FOR HEART FAILURE 1 , 2 †*
HR = 0.65 95 % CI : 0.5 , 0.85 ; p = 0.002 1 , 2
Additional benefits
†
Secondary endpoint . Not indicated , see full PI for further information . 1
Eli Lilly Australia Pty Limited , ABN 39 000 233 992
112 Wharf Road , West Ryde , NSW 2114 Australia . Copyright © 2023 .
39 % RRR
IN NEW OR WORSENING
NEPHROPATHY 2 , 3 †*#
HR = 0.61 95 % CI : 0.68 , 0.70 ; p < 0.001 . 3
* Standard of care included antihypertensives , lipid-lowering agents , anticoagulants and glucose-lowering therapies . Absolute risk for placebo vs JARDIANCE ® ( on a background of standard of care ): CV death : 5.9 % vs 3.7 %; HHF : 4.1 % vs 2.7 % and new or worsening nephropathy : 18.8 % vs 12.7 %. Secondary endpoints . Primary endpoint of 3P MACE was met , HR 0.86 , ( 95 % CI : 0.74,0.99 ) p = 0.04 , for superiority . 2
#
Defined as progression to macroalbuminuria ( urinary albumin-to-creatinine ratio , > 300 mg of albumin per gram of creatinine ); a doubling of the serum creatinine level , accompanied by an eGFR of ≤45 mL / min / 1.73 m 2 , as calculated by the MDRD formula ; the initiation of renal-replacement therapy ; or death from renal disease . 3
The GP ‘ had no faith in the justice system ’.
to police , in which he claimed there was CCTV footage of the robbery .
However , he never provided any footage , the tribunal said .
“[ The GP ] said he had not reported the burglary to Victoria Police because he was dissatisfied with what he saw as a lack of action by the police concerning a recent earlier burglary .
“[ He ] also described the patient coming to the practice without [ an ] appointment , not wearing a face mask and chatting to vulnerable patients .
“ It is striking in that [ the GP ] is calm , quietly spoken , businesslike and neutral as he answers questions from the police .”
The GP was fined $ 350 , with no conviction recorded , after pleading guilty to unlawful assault in the Magistrates Court of Victoria .
He was then suspended under emergency powers .
The tribunal said the GP had told the magistrate he planned to retire and that “ he had no faith in the justice system ”.
“ According to the court transcript , the magistrate imposed a low penalty given the penalty [ he ] had received : his practice had closed , his registration was suspended and he had lost income .”
The tribunal said it was “ surprised ” to learn during the case that the GP had been subject to 17 previous AHPRA complaints , although it did not go into detail .
It said the GP was already facing “ grave ” sanctions , with no excuses for his conduct and no evidence of mitigating circumstances .
“ There was no justification whatsoever for taking the law into his own hands ,” the tribunal wrote .
“[ His ] conduct was deliberate , unlawful and reckless . It posed a substantial risk to the patient and some risk to patients at the clinic who witnessed the conduct .”
It continued : “ While we do not speculate on the factors that brought [ him ] to assault the patient and then quietly and calmly admit to the assault and give up general practice , the outcome for him could have been so different if he had taken a co-operative path and , perhaps , admitted that he needed support and assistance moving forward .”
The tribunal said it was unlikely the GP would seek re-registration but added that , if he did , it would be “ no small task ” to persuade the board it was appropriate .