Management of type 2 diabetes: summary of updated NICE guidance

doi:10.1136/bmj.39560.442095.AD

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Philip Home, professor of diabetes medicine 1,
Jonathan Mant, professor of primary care stroke research2,
Jose Diaz, health services research fellow in guideline development3,
Claire Turner, senior project manager in guideline development for the development group 3
on behalf of the Guideline Development Group

¹Newcastle University, The Medical School, Newcastle upon Tyne
²Department of Primary Care and General Practice, University of Birmingham, Birmingham
³National Collaborating Centre for Chronic Conditions, Royal College of Physicians, London

Correspondence to: Professor P Home, SCMS-Diabetes, The Medical School, Framlington Place, Newcastle upon Tyne NE2 4HH philip.home{at}ncl.ac.uk

Why read this summary?

The prevalence of type 2 diabetes is rising rapidly.1 More than 240 million people worldwide are estimated to have diabetes, and this number is likely to reach over 360 million by 2030.1 2 The impact on health occurs primarily through cardiovascular disease, but younger age of onset and advances in the prevention of cardiovascular disease are increasingly exposing people to the risks of microvascular damage, such as kidney and eye disease.1

The management of diabetes is complex and needs to address the prevention of cardiovascular disease and microvascular disease and the detection and management of early vascular complications.3 In recent years new evidence has accumulated on lifestyle intervention, self management through education, and self monitoring, and many new treatments have been introduced for various aspects of management. This article summarises the recommendations from an updated guideline by the National Institute for Health and Clinical Excellence (NICE) on the management of type 2 diabetes.4

Recommendations

NICE recommendations are based on systematic reviews of best available evidence. When minimal evidence is available, recommendations are based on the opinion of the Guideline Development Group (GDG) of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Patient centred care

Offer structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review, informing people and their carers that structured education is an integral part of diabetes care. [Based on moderate quality evidence identified by a NICE technology appraisal and on a commissioned systematic review, and supplemented by the GDG’s experience of good clinical practice] A structured education programme implies an evidence based approach that is tailored to individual needs, is targeted at enhancing self management, has a formal curriculum, and is delivered by trained educators using …