Update information

Update information

June 2022: We reviewed evidence on periodontitis in people with type 1 diabetes, and made new recommendations. These recommendations are marked [2022].

March 2022: We reviewed evidence on the diagnosis of type 1 diabetes and continuous glucose monitoring (CGM). These recommendations are marked [2022].

We have also made some changes without an evidence review: In the first diagnosis recommendation, the term 'diagnosis' has been changed to 'initial diagnosis' to differentiate between this and later recommendations on revisiting the initial diagnosis.

  • The word 'centre' has been replaced with 'team' in a reference to a centre with expertise in the use of CGM, because community-based specialist teams are now available. In the same recommendation, the wording 'as part of a strategy to optimise a person's HbA1c levels and reduce the frequency of hypoglycaemic episodes' has also been simplified to 'supporting people to self-manage their diabetes'.

  • Recommendations in the section on self-monitoring of capillary blood glucose have been clarified to clearly differentiate adults who are using capillary blood glucose monitoring from those using CGM.

These recommendations are marked [2015, amended 2022].

Recommendations marked [2004] or [2015] last had an evidence review in that year. In some cases, minor changes have been made to the wording to bring the language and style up to date, without changing the meaning.

July 2021: We reviewed the evidence and updated the recommendations on long-acting insulin therapy for adults with type 1 diabetes. These recommendations are marked [2021].

We have also made some changes without an evidence review:

  • In recommendation 1.1.11, 'urine albumin excretion, urine protein and serum creatinine' was changed to 'urine albumin:creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR)' to bring the recommendation in line with NICE's guideline on chronic kidney disease.

  • In recommendation 1.2.2, the statement 'A common environment (diabetes centre) is an important resource in allowing a diabetes multidisciplinary team to work and communicate efficiently while providing consistent advice' was removed to reflect changes in practice and the fact that working in a coordinated approach does not rely on having a single location of care.

  • In recommendation 1.4.13, 'eating disorder' was changed to 'disordered eating' because it is a broader term that encompasses issues that are prevalent in type 1 diabetes.

  • In recommendation 1.11.11, heparin was replaced by venous thromboembolism (VTE) prophylaxis because there is more than 1 type of prophylaxis that could be used.

  • In recommendation 1.13.2, 'albuminuria' was changed to 'estimated glomerular filtration rate (eGFR) and urine albumin:creatinine ratio (ACR)' for consistency.

  • In recommendation 1.13.6, 'young' was removed from 'Advise young adults who do not smoke never to start smoking' so that it applies to all adults.

  • In recommendation 1.13.8, a cross-reference was added to the NICE guideline on hypertension in adults.

  • In recommendation 1.15.10, 'serum creatinine' was changed to 'eGFR' to bring the recommendation in line with NICE's guideline on chronic kidney disease, and a cross-reference was added to this guideline.

  • In recommendation 1.15.31 about initial measures for painful neuropathy, 'discontinue them' was removed because it contradicted recommendation 1.15.33, which stated to keep using them while trying further measures.

  • In recommendation 1.15.42, the term 'insulin dose manipulation' was changed to 'disordered eating' because the term encompasses issues that are prevalent in type 1 diabetes.

  • In recommendation 1.15.43, 'who are at risk of morbidity from the complications of poor metabolic control' was replaced by 'with an eating disorder' for clarity.

These recommendations are marked [2004, amended 2021] or [2004, amended 2015 and 2021].

In recommendation 1.15.28, specific recommendation numbers were replaced by 'interventions in this section'.

December 2020: Recommendations on diabetic retinopathy have been amended to bring them in line with the diabetic eye screening programme.

August 2015: This guidance updates NICE guideline CG15 (published July 2004). It also updates and replaces NICE technology appraisal guidance 53 and NICE technology appraisal guidance 60.

Some changes were made without an evidence review:

  • Recommendations 1.4.11, 1.4.12 and 1.4.14 were updated to remove mention of a low glycaemic index diet, because there is no evidence of benefit for this.

  • Recommendation 1.6.25 was amended to make it clear that self-monitoring skills should be taught as soon as type 1 diabetes is diagnosed.

  • Recommendation 1.6.29 has been amended to remove references to small volumes of blood (which is now normal for all meters) and devices for alternative site monitoring (which are not recommended anyway).

  • Recommendation 1.7.12 (now 1.7.16) was amended to remove a reference to resuspension of insulin, because this is out of date.

  • Recommendation 1.10.10 has been updated to reflect changes in practice for managing hypoglycaemia.

  • Recommendation 1.10.11 has been amended for clarity, and to highlight that glucagon can be given by untrained users in an emergency.

  • Recommendation 1.10.15 has been amended to remove out of date and inconsistent information about different types of insulin.

  • Recommendation 1.12.1 has been updated to remove low body mass index (BMI). This change brings the recommendation in line with NICE's guideline on coeliac disease.

  • Recommendation 1.12.2 has been updated to remove mention of thyroid disorders, which are now covered in a separate recommendation.

  • Recommendation 1.13.10 has been updated to reflect changes in hypertension management (covered in NICE's guideline on hypertension in adults).

  • Recommendation 1.14.8 has been updated to reflect changes in hospital practice around monitoring systems.

  • Recommendation 1.15.21 has been updated to mention postural hypotension, because this is an important sign of autonomic neuropathy.

Minor changes since publication

May 2022: We added a link to NICE's guideline on medicines associated with dependence or withdrawal symptoms in the section on acute painful neuropathy from rapid improvement of blood glucose control.

December 2021: We removed the reference to dapagliflozin in recommendation 1.7.18 because it is no longer licensed for treating type 1 diabetes.

ISBN: 978-1-4731-1389-3

  • National Institute for Health and Care Excellence (NICE)