Novo Nordisk says NICE diabetes guidance causes "grave concern"

In an open letter to Professor Sir Michael Rawlins, chairman of theNational Institute for Clinical Excellence (for England and Wales), Novo Nordisk, a leading producer of insulin, expresses "grave concerns" over the Institute's issuing of "confusing guidance" for the diabetes treatments pioglitazone and rosiglitazone (Marketletter March 19). While welcoming the addition of glitazones to the therapeutic armory in the treatment of diabetes, the company urges the Institute to ensure that the forthcoming type 2 guidelines on glycemic control will provide the clear advice that insulin should be initiated in patients with HbA1c levels above 7.5%.

The letter, from Novo Nordisk UK's managing director Ingelise Saunders, highlights that the NICE guidance may lead to patients not receiving or getting delayed insulin therapy, which is a life-saving treatment for some of the 1.3 million people with type 2 diabetes in England and Wales. It urges the NICE to immediately review the guidance "in the interests of patient safety."

The NICE has recommended to doctors that pioglitazone may be offered in combination with other drugs as an alternative to insulin, but Ms Saunders says "we are unaware of any peer review published evidence to support this view." She also cites diabetologists showing concern over the guidance, saying "there is no evidence to suggest that the thiazolidinediones [under which pioglitazone and rosiglitazone fall] are more effective than insulin in the long term."