Diabetes guidance 1766.pdf - East Cheshire NHS Trust

RetinopathyScreening will be provided via the Retinopathy Screening Service. Patients with no retinopathy /background retinopathy will be screened annually and the service will advise of the need for morefrequent screening or referral to ophthalmology.Antithrombotic Treatment• Aspirin is not recommended for the primary prevention of cardiovascular events in patients withdiabetes.• Aspirin 75mg dispersible should be considered as secondary prevention in establishedcardiovascular disease.• Clopidogrel 75mg daily is an alternative when aspirin cannot be tolerated.• Clopidogrel 75mg daily should be used in combination with aspirin 75mg daily for a limitedtime period following acute MI (1 month for STEMI and 1 year for NSTEMI) and some coronaryprocedures including stents.• Following thrombotic stroke aspirin 300mg daily is given for 2 weeks followed by clopidogrel75mg daily long term.• Following TIA aspirin 300mg daily is given for 2 weeks, then reducing to 75mg daily in combinationwith dipyridamole MR 200mg twice daily.Neuropathic Pain• Assess for symptoms of neuropathic pain annually and if present assess severity.• Where local measures and simple analgesics do not provide sufficient relief considerpharmacological management and if necessary referral to a specialist pain clinic.• NICE guidance (CG96) recommends duloxetine (Cymbalta 60mg daily) first-line and amitriptyline(10-75mg daily) as an alternative if duloxetine is contra-indicated or ineffective. Nortriptyline(starting dose 10mg) can be considered if amitriptyline is not tolerated.• NICE guidance recommends pregabalin if duloxetine / amitriptyline are not sufficiently effective orwell tolerated, but local guidance continues to recommend gabapentin as a lower cost alternativeto pregabalin with a similar NNT.