Commentary: controversies in NICE guidance on management of type 2 diabetes

BMJ 2008; 336 doi: (Published 05 June 2008) Cite this as: BMJ 2008;336:1308
  1. Stephen Atkin, professor of endocinology, diabetes and metabolism1,
  2. Christopher Walton, consulant diabetologist2
  1. 1Hull York Medical School, Michael White Diabetes Centre, Hull HU3 2RW
  2. 2Hull and East Yorkshire Hospital Trust, Michael White Diabetes Centre, Hull HU3 2RW
  1. Correspondence to: S Atkin Stephen.Atkin{at}

Publication of the original guidelines (in 2002) from the National Institute for Health and Clinical Excellence (NICE) for type 2 diabetes predated the wholesale change in the delivery of diabetes services in the England and Wales. As a consequence of the national service framework in 2001 and the new general practitioners’ contract in 2003, primary care now delivers much more diabetes treatment, with fewer instances of insulin being started in secondary care. Consequently, the revised guidance1 will now be judged much more on its relevance to general practice diabetes care, including the drive to hit targets on blood glucose control.

Initial management

It is reassuring that a trial of lifestyle intervention with education is still encouraged before a patient is started on metformin, rather than the immediate prescription of metformin at diagnosis as suggested in the consensus document from the American Diabetes Association and the European Association for the Study of Diabetes.2 The place of quality assured structured education programmes is rightly emphasised. However, the delivery …

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