This guidance partially updates and replaces NICE clinical guideline 66 (published in May 2008).
The advice in the NICE guideline covers:
- the monitoring of glucose, lipid (blood cholesterol and fat) and blood pressure levels
- diabetes education programmes
- dietary advice
- the use of medications to:
- control blood glucose
- prevent vascular (blood vessel) disease
- reduce blood pressure
- improve lipid levels
- the detection and ongoing management (with referral to a specialist if necessary) of:
- eye disease
- kidney disease
- nerve damage and nerve pain
It does not specifically look at:
- the prevention and management of foot problems related to diabetes (there is already guidance in this area – see CG10 Type 2 diabetes - footcare for more information)
- preventing type 2 diabetes or screening for it
- how specialists should manage problems caused by diabetes
- the management of diabetes during pregnancy (there is already guidance in this area – see CG63 Diabetes in pregnancy for more information).
Units for reporting HbA1c have changed from % to mmol/mol since this guideline was published. The NICE Pathway on diabetes has been changed to reflect this. The guideline is being updated and the new version (to be published in 2015) will use mmol/mol.
Recommendations 1.9.1 to 1.9.4, 188.8.131.52, 184.108.40.206, 220.127.116.11 to 18.104.22.168, 22.214.171.124, 126.96.36.199, 188.8.131.52, 184.108.40.206 and 220.127.116.11 have been updated and replaced by Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease (NICE clinical guideline 181)
The MHRA has issued new advice on risk of bladder cancer with the anti-diabetic drug pioglitazone.
The European Medicines Agency (EMA) and rosiglitazone
In September 2010 the EMA, the European Union (EU) body responsible for monitoring the safety of medicines, recommended the suspension of the marketing authorisation for rosiglitazone (Avandia, Avandamet and Avaglim) from GlaxoSmithKline. The EMA has concluded that the benefits of rosiglitazone no longer outweigh its risks and the marketing authorisation should be suspended across the EU.
The EMA has advised that patients who are currently taking rosiglitazone-containing medicines should make an appointment with their doctor at a convenient time to discuss suitable alternative treatments. Patients are advised not to stop their treatment without speaking to their doctor. NICE does not recommend the use of drugs without marketing authorisation. Therefore, as a result of the EMA's decision, NICE has temporarily withdrawn its recommendations on the use of rosiglitazone in this guideline.
Recommendations 18.104.22.168, 22.214.171.124, 126.96.36.199 and 188.8.131.52 in this guidelinehave been updated and replaced by Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings? (NICE clinical guideline 96).
NICE clinical guideline 87 partially updates NICE clinical guideline 66 and replaces it. Most of the recommendations were developed for NICE clinical guideline 66 by the National Collaborating Centre for Chronic Conditions. Details of the methods and evidence used to develop these recommendations are in CG66 Type 2 diabetes: full guideline. The recommendations on DPP-4 inhibitors (sitagliptin, vildagliptin), thiazolidinediones (pioglitazone, rosiglitazone), exenatide and insulin were developed by the Centre for Clinical Practice at NICE following the process for short clinical guidelines. Details of the methods and evidence used to develop these recommendations are in CG87 Type 2 diabetes - newer agents: short guideline.