Clinical Review

Type 1 diabetes in adults: supporting self management

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i998 (Published 10 March 2016) Cite this as: BMJ 2016;352:i998
  1. Monika Reddy, specialist registrar, diabetes and endocrinology1 2,
  2. Sian Rilstone, diabetes specialist dietitian2,
  3. Philippa Cooper, has type 1 diabetes3,
  4. Nick S Oliver, consultant diabetologist1 2
  1. 1Department of Diabetes, Endocrinology and Metabolism, Imperial College London, St Mary’s Hospital Campus, London W2 1PG, UK
  2. 2Diabetes and Endocrinology, Imperial Healthcare NHS Trust, London
  3. 3London
  1. Correspondence to: N S Oliver nick.oliver{at}imperial.ac.uk

What you need to know

  • Glucose concentrations in type 1 diabetes are affected by multiple interacting and independent complex factors

  • Structured education programmes support effective self management and should be available to everyone with an established diagnosis of type 1 diabetes

  • Long term self-management of type 1 diabetes is challenging and requires ongoing support from an expert multidisciplinary team

  • Insulin dose adjustment involves carbohydrate estimation and mental arithmetic, which can be supported with technology

  • Healthcare professionals should be alert to signs of depression or distress in people with type 1 diabetes, and access to psychosocial support is critical

Type 1 diabetes affects 300 000 people in the United Kingdom.1 2 Despite regular specialist multidisciplinary input, responsibility for glucose monitoring and insulin administration is devolved to the person with diabetes, or their care giver. Empowering effective self management of type 1 diabetes is critical to achieve HbA1c targets, minimise hypoglycaemia and optimise quality of life. Structured education programmes for diabetes self management should be offered to everyone with type 1 diabetes. It is important for healthcare providers to understand what structured education involves before referral. This review examines the meaning and evidence for self management, and provides advice on how general physicians and non-specialists can support and enable people with type 1 diabetes to self manage their condition.

Sources and selection criteria

A PubMed search using the terms “self management in type 1 diabetes” and “structured education in type 1 diabetes” was performed. The clinical evidence base included in the NICE guidelines on diagnosis and management of type 1 diabetes (NG17 2015) was reviewed. The reference list included in this review is not exhaustive, but includes the most relevant up to date studies.

What is required for self management of type 1 diabetes?

Insulin requirements and glucose concentrations are affected by multiple internal and external factors (see box 1), and maintaining glycaemic control while minimising hypoglycaemia with a flexible …

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