The guideline update focuses on tailoring advice and treatments to the person’s circumstances, including considering co-existing illnesses, and reassessing their needs at each review.

The guideline underlines the importance of structured education for adults with type 2 diabetes and/or their family members or carers to help them develop the knowledge and skills to self-manage diabetes. New recommendations on blood glucose management give clarity on the sequence of drug treatments to offer, and when to consider adding further drugs, to achieve and maintain target blood glucose (sugar) levels. An algorithm to help clinicians make decisions on drug treatments is a key feature of the guideline.

In addition to making recommendations on managing blood pressure and dietary advice, the guideline also covers managing complications including eye disease and erectile dysfunction, and points to related NICE guidance on diabetic foot problems.

Sir Andrew Dillon, NICE Chief Executive, said “Around 2.7 million people in the UK have type 2 diabetes. This long-term condition has a serious impact on people who live with it – but it can be managed successfully with advice, support and treatments that are tailored for the individual. This updated guideline focuses on the importance of putting each person’s needs and preferences at the heart of joint discussions and decision-making.  Following these evidence-based recommendations will enable health professionals to create individual packages of care to prevent serious illnesses linked to diabetes.  And to ensure the guideline keeps pace with new developments in diabetes care, NICE has plans in place to establish a standing subcommittee on diabetes within its guideline updates programme.”

A person with type 2 diabetes has too much glucose (sugar) in their blood. This can either be because their body doesn’t produce enough insulin – the hormone which controls the amount of glucose in blood – or their body doesn’t use insulin effectively. Around 90% of all adults currently diagnosed with diabetes have type 2 diabetes. If blood glucose levels are not managed effectively it causes tissue damage which can result in blindness, kidney failure, foot ulcers which can lead to amputation, and also premature heart disease, stroke and death. Type 2 diabetes is more common in people of African, African Caribbean and South Asian family origin.

Type 2 diabetes guideline recommendations include:

• Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences, comorbidities, risks from polypharmacy, and their ability to benefit from long term interventions because of reduced life expectancy
• Monitor blood pressure every 1–2 months, and intensify therapy if the person is already on antihypertensive drug treatment, until the blood pressure is consistently below 140/80 mmHg (below 130/80 mmHg if there is kidney, eye or cerebrovascular damage)
• Integrate dietary advice with a personalised diabetes management plan, including other aspects of lifestyle modification, such as increasing physical activity and losing weight
• Offer standard-release metformin as the initial drug treatment for adults with type 2 diabetes
• In adults with type 2 diabetes, if HbA1c levels are not adequately controlled by a single drug and rise to 58 mmol/mol (7.5%) or higher: reinforce advice about diet, lifestyle and adherence to drug treatment and support the person to aim for an HbA1c level of 53 mmol/mol (7.0%) and intensify drug treatment
• In adults with type 2 diabetes, measure HbA1c levels at: 3–6-monthly intervals (tailored to individual needs), until the HbA1c is stable on unchanging therapy; 6-monthly intervals once the HbA1c level and blood glucose lowering therapy are stable.

Dr Amanda Adler, consultant diabetologist and NICE guideline developer said: “This update to the guideline for type 2 diabetes is good news for people with type 2 diabetes and for health professionals given the many therapies now available. The guideline comprehensively covers the best care for patients with type 2 diabetes taking into account effectiveness of medications, enhancing quality of life, and wisely using NHS resources.  

“The guideline encourages all patients to eat well and be physically active. For the many adults with type 2 diabetes who do require drugs to help manage their diabetes, the guideline details treatments and includes an algorithm which summarises the range of treatment options at a glance.”

Dr Ian Lewin, NICE guideline developer and retired consultant endocrinologist, commented: “The guideline highlights that putting people with type 2 diabetes at the centre of their care package is essential. For example the guideline recommends that adults with type 2 diabetes should be involved in decisions about their individual HbA1c target – the average amount of glucose in their blood over 2 to 3 months.  Health professionals are also advised to individualise recommendations for carbohydrate intake and alcohol intake, and meal patterns. All of these steps should result in improved outcomes for adults with type 2 diabetes – reduced complications and better health.”

The updated type 2 diabetes guideline is available at http://www.nice.org.uk/ng28. 

Ends

For more information call Dr Tonya Gillis at the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

About the guidance

1. The updated guideline, ‘Type 2 diabetes in adults: management’ is available at http://www.nice.org.uk/guidance/ng28 from Wednesday 2 December 2015. 
2. The Information for Patients version of the guideline which also suggests points that adults with type 2 diabetes may find helpful to discuss with their doctor or nurse will be available at http://www.nice.org.uk/guidance/ng28/informationforpublic.
3. The algorithm for blood glucose lowering therapy in adults with type 2 diabetes is available at http://www.nice.org.uk/guidance/ng28/resources.
4. The HbA1c test is a blood test that reflects the average blood glucose level over the previous 2 to 3 months. In people without diabetes, it is usually below 42 mmol/mol (or 6%). The HbA1c target for most people with type 2 diabetes is 48 mmol/mol (or 6.5%), but clinicians may suggest a different target for different people.
5. The other three updated diabetes guidelines, published in August 2015, are:

• ‘Type 1 diabetes in adults: diagnosis and management’ – http://www.nice.org.uk/guidance/ng17
• ‘Diabetes (type 1 and type 2) in children and young people: diagnosis and management’ – http://www.nice.org.uk/guidance/ng18
• ‘Diabetic foot problems: prevention and management’ – http://www.nice.org.uk/guidance/ng19.

    6.   This new publication completes the suite of updated guidelines from NICE to improve management of diabetes in children and adults.  It also marks the completion of the update to the NICE diabetes pathway. NICE has produced a wide range of guidance on diabetes, including preventing type 2 diabetes, diabetes in pregnancy, and drug treatments to lower blood glucose levels. The pathway helps people find what they are looking for and see how all of the guidance fits together. The diabetes pathway is available at: http://pathways.nice.org.uk/pathways/diabetes.