Diabetes in adults quality standard
- People with diabetes and/or their carers receive a structured educational programme that fulfils the nationally agreed criteria from the time of diagnosis, with annual review and access to ongoing education.
- People with diabetes receive personalised advice on nutrition and physical activity from an appropriately trained healthcare professional or as part of a structured educational programme.
- People with diabetes participate in annual care planning which leads to documented agreed goals and an action plan.
- People with diabetes agree with their healthcare professional a documented personalised HbA1c target, usually between 48 mmol/mol and 58 mmol/mol (6.5% and 7.5%), and receive an ongoing review of treatment to minimise hypoglycaemia.
- People with diabetes agree with their healthcare professional to start, review and stop medications to lower blood glucose, blood pressure and blood lipids in accordance with NICE guidance.
- Trained healthcare professionals initiate and manage therapy with insulin within a structured programme that includes dose titration by the person with diabetes.
- Women of childbearing age with diabetes are regularly informed of the benefits of preconception glycaemic control and of any risks, including medication that may harm an unborn child. Women with diabetes planning a pregnancy are offered preconception care and those not planning a pregnancy are offered advice on contraception.
- People with diabetes receive an annual assessment for the risk and presence of the complications of diabetes, and these are managed appropriately.
- People with diabetes are assessed for psychological problems, which are then managed appropriately.
- People with diabetes with or at risk of foot ulceration receive regular review by a foot protection team in accordance with NICE guidance, and those with a foot problem requiring urgent medical attention are referred to and treated by a multidisciplinary foot care team within 24 hours.
- People with diabetes admitted to hospital are cared for by appropriately trained staff, provided with access to a specialist diabetes team, and given the choice of self-monitoring and managing their own insulin.
- People admitted to hospital with diabetic ketoacidosis receive educational and psychological support prior to discharge and are followed up by a specialist diabetes team.
- People with diabetes who have experienced hypoglycaemia requiring medical attention are referred to a specialist diabetes team.
This NICE quality standard defines clinical best practice within this topic area. It provides specific, concise quality statements, measures and audience descriptors to provide patients and the public, health and social care professionals, commissioners and service providers with definitions of high-quality care.
Rationale for developing this quality standard
Diabetes mellitus is a chronic complex metabolic disorder characterised by high levels of blood glucose and caused by defects in insulin secretion and/or action. As of 2009, nearly 2 million people in the UK were registered as having diabetes, and it is estimated that by 2025 more than 4 million people will have diabetes. Diabetes increases the risk of damage to the heart, eyes, kidneys, nerves, heart and blood vessels. Good care and education can reduce the risk of these problems.
Since high blood glucose, blood pressure and cholesterol can worsen many of these problems, managing diabetes draws on many areas of healthcare, and care is typically complex and time-consuming. The importance of a healthy lifestyle avoiding the problems caused by diabetes, and, for some, monitoring blood glucose and altering doses of insulin, makes education for people with diabetes a central part of management. This quality standard describes high-quality, cost-effective care that, when delivered collectively, should improve the effectiveness, safety and experience of care for adults with diabetes.
Scope of the quality standard
Clinical management of diabetes in adults excluding children, young people and pregnant women.
Diabetes in adults quality statements
The quality standard for diabetes in adults requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole diabetes care pathway. An integrated approach to provision of services is fundamental to the delivery of high quality care to people with diabetes. The diabetes in adults quality standard supports the National Service Framework for Diabetes and locally agreed pathways of care.
View the Diabetes in adults areas of care map to see the quality statements mapped against the areas of care for diabetes in adults.
Policy context
Department of Health (2010) The NHS Outcomes Framework 2011/12. Available from www.dh.gov.uk
Department of Health (2010) Six years on: delivering the Diabetes National Service Framework. Available from www.dh.gov.uk
NHS Diabetes (2009) Commissioning Diabetes Without Walls. Available from www.diabetes.nhs.uk
Department of Health (2008) Five years on: delivering the diabetes National Service Framework. Available from www.dh.gov.uk
Department of Health (2006) Diabetes Commissioning Toolkit. Available from www.dh.gov.uk
Department of Health (2004) The way ahead: the local challenge. Improving diabetes services. Available from www.dh.gov.uk
Department of Health (2003) National Service Framework for diabetes: delivery strategy. Available from www.dh.gov.uk
Department of Health (2001) National Service Framework for Diabetes. Available from www.dh.gov.uk
Key development sources
Diabetic foot problems: inpatient management of diabetic foot problems. NICE clinical guideline 119 (2011; NHS evidence accredited). Available from www.nice.org.uk/CG119
Type 2 diabetes: the management of type 2 diabetes. NICE clinical guideline 87 (2009; NHS Evidence accredited). Available from www.nice.org.uk/CG87
Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period. NICE clinical guideline 63 (2008; NHS Evidence accredited). Available from www.nice.org.uk/CG63
Type 1 diabetes: diagnosis and management of type 1 diabetes in children, young people and adults. NICE clinical guideline 15 (2004; NHS Evidence accredited). Available from www.nice.org.uk/CG15
Type 2 diabetes: prevention and management of foot problems. NICE clinical guideline 10 (2004; NHS Evidence accredited). Available from www.nice.org.uk/CG10
Liraglutide for the treatment of type 2 diabetes mellitus. NICE technology appraisal 203 (2010; NHS Evidence accredited). Available from www.nice.org.uk/TA203
Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus. NICE technology appraisal 151 (2008; NHS Evidence accredited). Available from www.nice.org.uk/TA151
Guidance on the use of patient-education models for diabetes. NICE technology appraisal 60 (2003; NHS Evidence accredited). Available from www.nice.org.uk/TA60
Joint Department of Health and Diabetes UK Care Planning Working Group (2006) Care Planning in Diabetes. Available from www.dh.gov.uk
Joint Department of Health and Diabetes UK Patient Education Working Group (2005) Structured Patient Education in Diabetes: Report from the Patient Education Working Group. Available from www.dh.gov.uk
Development team
Director Fergus Macbeth
Associate Director Nicola Bent
Consultant Clinical Adviser Tim Stokes
Lead Analyst Denise Dutton
Consultation feedback
Consultation on the diabetes quality standard took place from 4 November to 16 December 2010. In total, 456 stakeholders were contacted during consultation. All eligible comments were reviewed by the Topic Expert Group and the standard was updated accordingly.
Implementation support materials
Publication partners
Many organisations share NICE's commitment to improve quality by making it clear what quality care is for patients and the public, health and social care professionals, commissioners and service providers.
So that these standards reach the widest possible audience, some of the organisations who have been involved in the development process, and who endorse the diabetes in adults quality standard, have become partners in its publication.
These organisations are:
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Issued: March 2011
This page was last updated: 15 July 2011
