Australian Doctor 6th Dec Issue | Page 4

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6 DECEMBER 2024 ausdoc . com . au

Guidance update for T2DM

Dr Gary Deed .

Multicomponent Meningococcal group B vaccine ( recombinant , adsorbed )

Rachel Fieldhouse TYPE 2 diabetes treatments , such as low-calorie diets and bariatric surgery , can lead to remission for some patients , says new guidance from the RACGP and Diabetes Australia .

Management of Type 2 Diabetes : A Handbook for General Practice now defines remission as HbA1c of less than 6.5 %, maintained for at least three months without glucoselowering medication .

For these patients , it recommends HbA1c testing every six months to watch for relapse .

The handbook urges doctors to inform patients about “ the potential for remission as a goal of treatment at the time of diagnosis and in the first few years following diagnosis ”.

But it may not be realistic for every patient ,

nor should patients stop medication that reduces their cardiovascular or kidney disease risk , it says .

Other new sections in the handbook — last updated in 2020 — cover weight management , sleep , and dementia and cognitive decline .

Queensland GP Dr Gary Deed , the handbook ’ s clinical editor , says there are detailed updates on diabetes in young people that

If you don ’ t recommend MenB vaccination to your patients ,

Meningococcal B continues to be the predominant strain that causes IMD in Australia . 1

The persons depicted are models used for illustrative purposes only .

FOR AUSTRALIAN HEALTHCARE PROFESSIONALS

who will ?

2 out of 3 parents were not fully aware that different meningococcal vaccines help protect against different types of meningococcal disease . ^ * 2

^ 32 % of respondents in Australia were fully aware that different meningococcal vaccines help protect against different types of meningococcal disease . 2

* Respondents to an online survey conducted by IPSOS ( on behalf of GSK ) between 27th March and 12th April 2019 , in multiple countries . Respondents in Australia ( n = 500 ) were parents / guardians of a child aged 2 months to 10 years . The intent of the survey was to gather insights into the knowledge that parents / guardians have about invasive meningococcal disease vaccines . 2

Bexsero Indication : 3 Bexsero is indicated for active immunisation against invasive meningococcal disease caused by Neisseria meningitidis group B strains in individuals from 2 months of age and older .

Bexsero Contraindication : 3 Hypersensitivity to any vaccine component .

Bexsero Safety Information : 3 The most common adverse effects observed in clinical trials were as follows : In infants , toddlers & children ( up to 10 years of age ): injection site reactions , fever ( ≥38 ° C ), irritability , eating disorders , diarrhoea , headache , vomiting , rash , unusual crying , sleepiness and arthralgia . In adolescents ( from 11 years of age ) & adults : injection site reactions , headache , nausea , malaise , myalgia and arthralgia .

References : 1 . Department of Health . Communicable Diseases Intelligence Australian Meningococcal Surveillance Programme Annual Report , 2022 . 2023 . Volume 47 https :// doi . org / 10.33321 / cdi . 2023.47.44 [ accessed Sep 2024 ]. 2 . Ballalai I et al . Expert Rev Vaccines 2023 ; 22 ( 1 ): 457-467 . 3 . Bexsero Product Information .

PBS Information : This product is listed on the National Immunisation Program ( NIP ) for Aboriginal and Torres Strait Islander children aged < 2 years and for people of all ages with some medical risk conditions . Refer to NIP schedule or your state or territory health department . This product is not listed on the PBS .

Scan QR code to access the full Product Information , also available at www . gsk . com . au / bexsero . Please review Product Information before prescribing . For information on GSK products or to report an adverse event involving a GSK product , please contact GSK Medical Information on 1800 033 109 . GlaxoSmithKline Australia Pty Ltd ABN 47 100 162 481 , Melbourne , VIC . Trade marks are owned by or licensed to the GSK group of companies . © 2024 GSK group of companies or its licensor . PM-AU-BEX-ADVR-240001 Date of Approval : September 2024

Inform patients about ‘ the potential for remission as a goal ’.

IMD : Invasive meningococcal disease

Please review Product Information before prescribing . Scan QR code to access the full Product Information , also available at www . gsk . com . au / bexsero stress early intervention , preventing complications and mental health support .

“ We want to have these people managed well because they might be living with diabetes for maybe 60 or more years ,” he tells Australian Doctor .

The handbook advises GPs to screen children annually from age 10 or puberty onset if they have risk factors , such as overweight or obesity , signs of insulin resistance or a maternal history of diabetes or gestational diabetes .

For adults , the handbook recommends considering the dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist tirzepatide before insulin .

It also recommends the use of the mineralocorticoid receptor agonist finerenone for patients with diabetic chronic kidney disease .

Continuous glucose monitoring should be considered for all patients on intensive insulin therapy , as well as pregnant women with severe hypoglycaemia or unstable blood glucose levels , it says .

For patients aged 65 or older , annual dementia screening is recommended .

For aged care residents , it recommends screening for polypharmacy , cognitive impairment , falls , frailty and urinary incontinence .

“ In the presence of cognitive impairment , diabetes treatment plans should be simplified as much as possible and tailored to minimise the risk of hypoglycaemia ,” the handbook authors said . Updated T2DM handbook : bit . ly / 493Z7P4

Correction

IN the 8 November edition of Australian Doctor , we published an article on page 6 with the headline ’ Input error led to fatal overdose ’. The article stated that the surgery and the prescription error had occurred at Calvary Hospital in Canberra . This was incorrect . The patient had been transferred to Canberra Hospital for surgery after being taken by ambulance to Calvary Hospital , where she was assessed by doctors . Australian Doctor apologies for the error .