Practice Guidelines

Diagnosis and management of type 1 diabetes in adults: summary of updated NICE guidance

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4188 (Published 26 August 2015) Cite this as: BMJ 2015;351:h4188
  1. Stephanie A Amiel, guideline development group chair, RD Lawrence professor of diabetic medicine1,
  2. Nancy Pursey, senior project manager2,
  3. Bernard Higgins, clinical director, consultant respiratory physician3,
  4. Dalia Dawoud, health economist, lecturer4
  5. on behalf of the Guideline Development Group
  1. 1Division of Diabetes and Nutritional Sciences, King’s College London, London, UK
  2. 2National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  3. 3National Clinical Guideline Centre, Royal College of Physicians, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  4. 4National Clinical Guideline Centre, Royal College of Physicians, Faculty of Pharmacy, Cairo University, Cairo, Egypt
  1. Correspondence to: N Pursey nancy.pursey{at}rcplondon.ac.uk

The bottom line

  • Offer all adults with type 1 diabetes a structured education programme in self management of diabetes six to 12 months after diagnosis or, if this was not achieved, at any time that is clinically appropriate and suitable for the person

  • Support adults to aim for a target glycated haemoglobin 48 mmol/mol (6.5%) or lower, to minimise risk of vascular complications; ensure that aiming for the target is not accompanied by problematic hypoglycaemia, and support four to 10 daily self monitoring blood tests as routine

  • Offer all adults daily basal-bolus insulin injection regimens, with twice daily insulin detemir as basal insulin therapy and rapid acting insulin analogues injected before meals for mealtime insulin “boluses”

  • Assess awareness of hypoglycaemia at least annually using a scoring system

How patients were involved in the creation of this article

Patients were involved at every stage of creating the guideline. Patient groups and individuals contributed to the scoping of the update and at the consultation stage. Lay members were active in the Guideline Development Group, contributing to the formulation of the recommendations summarised here, and were instrumental in setting the new treatment targets.

Having type 1 diabetes reduces the life expectancy of adults in the United Kingdom by as much as 13 years.1 Despite incontrovertible evidence that good care reduces the risk of complications such as blindness, renal failure, and premature cardiovascular disease and death,2 as well as complications of treatment such as severe hypoglycaemia,3 fewer than 30% of UK adults with type 1 diabetes achieve current national treatment targets for glucose control.4 The challenges of managing type 1 diabetes do not lessen after the age of 18 years. Since the publication of the 2004 National Institute for Health and Care Excellence (NICE) guideline, new technologies to achieve diabetic control have become available—for example, insulin analogues, new glucose meters, and real time …

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