Many more women are being diagnosed with diabetes in pregnancy since the National Institute for Health and Care Excellence (NICE) lowered the threshold as part of its updated guidance on the clinical topic. Women who are told they have the condition should be provided with advice about diet and exercise, and women who have diabetes and are planning a pregnancy should be informed that not achieving good control of their blood sugar levels increases the risk of congenital malformations.

Stricter blood glucose control was also recommended in NICE guidance for children and young people with diabetes, with the aim of reducing the impact diabetes can have on future health. Type 1 diabetes did not escape NICE's scrutiny, with sufferers advised to get a handle on their glycaemic control via more frequent selftesting as a way of minimising the risk of problems with their circulation.

On a related note, the organisation's updated guidelines on diabetic foot problems made it clear that pharmacists and their teams have a valuable part to play in explaining basic foot care to all diabetes patients, regardless of their age. The European Medicines Agency emphasised the need for care when prescribing and dispensing certain insulin products. The high strength (100 units per ml or higher) formulations Tresiba, Humalog and Toujeo, the fixed insulin degludec and liraglutide combination Xultophy, and Abasaglar, a biosimilar of insulin glargine, were singled out as potential sources of confusion.

Pharmacy support staff can reduce the risk to patients by making sure they are supplied with the correct products plus an insulin passport or safety card, and by checking they know how to use their medication.

Strengthened warnings were issued about restricting the use of sodium valproate and related medicines during pregnancy or in women of childbearing age to cases in which no other treatments are effective or tolerated. This is because babies exposed to the drugs in utero are at high risk of congenital malformations and developmental disorders such as autism.

Mirabegron should not be taken by patients with severe uncontrolled hypertension, and all patients prescribed the drug, which is used in managing overactive bladder syndrome, should have their blood pressure monitored regularly. These constraints were announced in response to the reporting of several cases in which severe hypertension had been linked to the drug €“ in some cases causing problems such as stroke and transient ischaemic attack.

The Yellow Card scheme for adverse effect reporting is well established and understood but was expanded in 2015 to include devices and suspected counterfeit and defective medicines. A mobile app was also launched, as was the case for the British National Formulary and the children's version, both of which were restricted to make them quicker and easier to use.

Pharmacy technicians were mentioned in guidance on medicines optimisation brought out by NICE, which listed them alongside other professionals such as pharmacists, doctors and nurses as €trained and competent€ to carry out medicines reconciliation. Pharmacy is also ideally located to help people put into action the interventions suggested by the organisation as potentially delaying or preventing the onset of dementia, disability and frailty in later life: stopping smoking, being more active, reducing alcohol intake and improving diet.