Introduction

This guidance updates and replaces 'Type 2 diabetes' (NICE guideline CG87). The recommendations are labelled according to when they were originally published (see update information for details).

Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance (that is, the body's inability to effectively use insulin) and insufficient pancreatic insulin production, resulting in high blood glucose levels (hyperglycaemia). Type 2 diabetes is commonly associated with obesity, physical inactivity, raised blood pressure, disturbed blood lipid levels and a tendency to develop thrombosis, and therefore is recognised to have an increased cardiovascular risk. It is associated with long‑term microvascular and macrovascular complications, together with reduced quality of life and life expectancy.

In 2013, over 3.2 million adults were diagnosed with diabetes, with prevalence rates of 6% and 6.7% in England and Wales respectively. It is estimated that about 90% of adults currently diagnosed with diabetes have type 2 diabetes. Type 2 diabetes is more common in people of African, African‑Caribbean and South Asian family origin. It can occur in all age groups and is increasingly being diagnosed in children.

Multiple vascular risk factors and wide‑ranging complications make diabetes care complex and time‑consuming, and many areas of healthcare services must be involved for optimal management. Necessary lifestyle changes, the complexities and possible side effects of therapy make patient education and self‑management important aspects of diabetes care. Diabetes care is estimated to account for at least 5% of UK healthcare expenditure, and up to 10% of NHS expenditure.

This guideline contains recommendations for managing type 2 diabetes in adults, and focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long‑term complications. The guideline does not cover diagnosis, secondary diabetes, type 1 diabetes in adults, diabetes in pregnancy and diabetes in children and young people.

Reasons for the update

Since the publication of the 2009 guideline, availability of new evidence and several key developments have prompted an update in the following areas: managing blood glucose levels, antiplatelet therapy and erectile dysfunction. In particular, reasons included safety concerns surrounding some blood glucose lowering medicines, new evidence on new dipeptidyl peptidase‑4 (DPP‑4) inhibitors and glucagon‑like peptide‑1 (GLP‑1) receptor agonists, new indications and licensed combinations for licensed class members and the potential impact of drugs coming off patent on health‑economic issues. In addition, new evidence and safety issues relating to the off‑label use of antiplatelet therapy (aspirin and clopidogrel) in the primary prevention of cardiovascular disease motivated an update of this review.

Medicines

The guideline will assume that prescribers will use a medicine's summary of product characteristics to inform decisions made with individual patients.

This guideline recommends some medicines for indications for which they do not have a UK marketing authorisation at the date of publication, if there is good evidence to support that use. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. The patient (or those with authority to give consent on their behalf) should provide informed consent, which should be documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information. Where recommendations have been made for the use of medicines outside their licensed indications ('off‑label use'), these medicines are marked with a footnote in the recommendations.

  • National Institute for Health and Care Excellence (NICE)