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The video version of this podcast can be found here: https://youtu.be/W0LL-1BwV3w?si=OT-GNCXaHoA7dcbs This podcast makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE. My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this video I will go through a National Patient Safety Alert released on 3.1.2024 by the Department of Health and NHS England on the shortage of GLP1 receptor agonists, touching on sections of the NICE guideline on type 2 diabetes as well as relevant pharmaceutical information, always focusing on what is relevant in Primary Care only.  I am not giving medical advice; this video is intended for health care professionals; it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.    There is a podcast version of this and other videos that you can access here:  Primary Care guidelines podcast:   ·      Redcircle: https://redcircle.com/shows/primary-care-guidelines ·      Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK ·      Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148 There is a YouTube version of this and other videos that you can access here:  • The Practical GP YouTube Channel:  https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk  The PDF document related to the safety alert on GLP- RA shortage can be found here: ·      https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAttachment.aspx?Attachment_id=104161 The safety alert on GLP- RA shortage can be found here: ·      https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103245 The Central Alerting System Homepage can be found here: ·      https://www.cas.mhra.gov.uk/Home.aspx Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release]  • Music provided by Audio Library Plus  • Watch: https://youtu.be/aBGk6aJM3IU (https://www.youtube.com/watch?t=0s&v=aBGk6aJM3IU)   • Free Download / Stream: https://alplus.io/halfway-through (https://www.youtube.com/redirect?event=video_description&q=https%3A%2F%2Falplus.io%2Fhalfway-through&redir_token=QUFFLUhqbVNpZlBNM0lCeDIxQzRkU29qUnJGQy15WEtTQXxBQ3Jtc0tuUUFSMkZwSEVuaHdUTWlYV21fZmpjWS1WRXI3R0hZU056MkpmRFpKdXdGYm1La3BlazhUemZ5SkVMTFdaWWRvSG9Ucy1neWpudTJ0MUIxNnl2NmhvR0lmdzduWXEwUUg0alduYkRNdjlWWTNsMnhzaw&v=aBGk6aJM3IU)   Transcript If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the top right corner of the video and in the episode description. Hello and welcome, I am Fernando, a GP in the UK. In this episode I will go through a National Patient Safety Alert released on 3.1.2023 by the Department of Health and NHS England on the shortage of GLP1 receptor agonists, touching on sections of the NICE guideline on type 2 diabetes as well as relevant pharmaceutical information, always focusing on what is relevant in Primary Care only. If you want to access the safety alert website or the associated PDF document, the link is in the episode description. Right, let’s jump into it. You are probably aware that the supply of GLP-1 receptor agonists continues to be limited, with supplies not expected to return to normal until at least the end of 2024. The supply issues have been caused by an increase in demand for these products for licensed and off-label indications. The situation at the moment is that exenatide as Byetta® will be discontinued in March 2024. In addition, liraglutide as Victoza® continues to be out of stock and further stock is not expected until end of 2024. The supply of other agents such as injectable semaglutide as Ozempic® and Dulaglutide as Trulicity® may be unreliable and the shortages may cause significant issues. So, what is the solution? Well, oral semaglutide has come to the rescue. Semaglutide as Rybelsus® tablets are now available in sufficient quantities to support initiation of GLP-1 RA for type 2 diabetes in line with NICE guidance.  So let’s remind ourselves of what NICE recommends for type 2 diabetes.  NICE says that if triple therapy with metformin and 2 other oral drugs is not effective, not tolerated or contraindicated, we can consider triple therapy by switching one drug for a GLP‑1 receptor agonist if: ·      The BMI is 35 or higher and there are psychological or medical problems associated with obesity. We will adjust the BMI to 32.5 for people from Black, Asian and other minority ethnic groups or ·      For lower BMIs if: o  insulin would have occupational implications or o  weight loss would benefit other significant comorbidities.   NICE also says that we should only ...

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SlimSmart® tablets contain 100% nature ingredients. Hydroxycitric acid (HCA) in Garcinia cambogia as a natural substance in inhibiting lipogenesis, lowers the production of cholesterol & fatty acids, increases the production of glycogen in the liver, suppresses appetite, increases the body’s production of heat by activating the process of thermogenesis, and encourages weight-loss. Piper Nigrum is another powerful “Thermogenic Herbs” to enhance thermogenesis of Fat molecules and accelerates Energy Metabolism in our body. Piper nigrum especially traps and enhances the thermogenesis of saturated fats which are most difficult to be cleaned by physical activity. Piper nigrm also suppress excess appetite. Thermogenic herbs serves as: † A Fat Burner † A Metabolism Booster † An Energy Accelerator † An Appetite Suppressant Side effects: No known side effects are therapeutic dose. No known interactions with any other herbal dietary supplement or drug. Precautions: During pregnancy and lactation women and young children are advised to avoid because they need nutrients for their health status. Results: SlimSmart® can help reduce weight 1 kg (2.2 pounds) per week. Both Garcinia cambogia and its extracted HCA are widely available in North America as a component in many commercial dietary supplements. In 1965, researchers identified Hydroxycitric Acid (HCA) as the principle substance found in the fruit and rind of Garcinia cambogia. It is promoted as a weight loss agent because of HCA. What is Hydroxycitric Acid (HCA)? Garcinia cambogia is a unique source of Hydroxycitric Acid (HCA). HCA has been studied extensively in the animal model and found to suppress fatty acid synthesis and food intake, in addition to sparing the use of carbohydrate in the body while causing an increase in fat oxidation. Weight loss was also common within the animal model. Garcinia cambogia does not affect the central nervous system, then people who tried the herbs are not likely to gain weight after stopping. Advantages of HCA HCA hastens the combustion of fat store into energy during prolonged exercise. Inhibits the accumulation of fat as a result of consumption of carbohydrates and sugar. Neutralizes the function of the enzyme ATP citratelies.* Of which the enzyme reduces the accumulation of fat and cholesterol in parts of the body. Glycogen is accumulated, then the body system can have sufficient energy, vitamins and minerals from the consumption of food. Reduce appetite by raising the amount of serotonin in the body. Serotonin is a neurotransmitter that is believed to affect appetite control. Appetite reduction occurs because the body cannot accumulate fat and cholesterol. This elevates the amount of Glycogen, hence a “full” signal is transmitted to a part of brain which controls appetite. Therefore, the amount of food we take is in balance with what the body needs. * The reputed effects of hydroxycitrate are based on its action as a potent inhibitor of the enzyme ATP citrate lyase (also known as citrate cleavage enzyme), which is required for the synthesis of fatty acids. The enzyme takes citrate, which has been exported from the mitochondria to the cytoplasm, and forms acetyl CoA and oxaloacetate from it. Source: Watson, J.A., Fang, M., and Lowenstein, J.M. (1969) “Tricarballylate and Hydroxycitrate: Substrate and Inhibitors of ATP:Citrate Oxaloacetate Lyase.” Arch. Biochem. Biophys. 135, 209-217 1. PIPER NIGRUM, the second Thermogenic Herb Scientific name: Piper nigrum Linn. Other names: Black pepper, Maricha Piper nigrum is another active ingredient in our unique formula. It is “thermogenic herb”. It enhances thermo-genesis of lipid (fat molecules) and accelerates energy metabolism in the body. It particularly traps and enhances the thermo-genesis of saturated fats which are most difficult to be by physical activity. It also exerts local anesthetic effect in stomach, then suppressing excess appetite. Piper nigrum is another active ingredient in our unique formula. It is “thermogenic herb”. It enhances thermo-genesis of lipid (fat molecules) and accelerates energy metabolism in the body. It particularly traps and enhances the thermo-genesis of saturated fats which are most difficult to be by physical activity. It also exerts local anesthetic effect in stomach, then suppressing excess appetite. Weight Loss Disclaimer: Results May Vary: Causes for being overweight or obese vary from person to person. Whether genetic or environmental, it should be noted that food intake, rates of metabolism and levels of exercise and physical exertion vary from person to person. This means weight loss results will also vary from person to person. No individual result should be seen as typical.

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