Prescribing guide: individualising medicines use for people with type 2 diabetes
Holistic care
This prescribing guide supports the implementation of NICE's guideline on type 2 diabetes in adults.
Type 2 diabetes is a complex cardiometabolic condition. There is good evidence that managing it should aim to improve a person's health holistically, rather than just focussing on the glycaemic benefits of medicines. This means that related cardiovascular and renal conditions, or risk factors for these, will also need managing.
NICE's updated guideline on type 2 diabetes in adults focuses on managing diabetes in the context of the comorbidities common in people with type 2 diabetes. It does not replace other, separate NICE guidelines on treating those comorbidities. NICE currently has separate guidelines on managing:
Medicines used for managing type 2 diabetes may also be covered by NICE technology appraisal guidance about their use in diabetes or related conditions. This guidance may reflect former treatment pathways. This does make it challenging to find all the guidance that is relevant for a particular person. Work is ongoing to address this through 2 workstreams: bringing our guidance together by topic and NICE's whole life-cycle approach, as explained in NHS 10 year plan: empowering NICE to get better care to people, faster.
A person-centred approach
Recommendation 1.1.1 in NICE's guideline on type 2 diabetes in adults advocates for an individualised approach to diabetes care that takes account of the person's preferences, comorbidities and risks from polypharmacy, and their likelihood of benefiting from long-term interventions. As with all NICE guidelines, treatment recommendations do not override the responsibility to make decisions appropriate to the circumstances of the individual person, in consultation with them.
An approach to care that takes account of multimorbidity
The guideline should be read and implemented in the context of NICE's guideline on multimorbidity. This defines multimorbidity as the presence of 2 or more long-term health conditions (not limited to defined physical and mental health conditions) and has a section on the principles and delivery of an approach to care that takes account of multimorbidity, which expands on recommendation 1.1.1 in NICE's guideline on type 2 diabetes in adults.
Selecting and prioritising treatment pathways
Some people with type 2 diabetes have more than one related comorbidity. Recommendation 1.9.3 in NICE's guideline on type 2 diabetes in adults recommends making a shared decision with a person about which comorbidity to prioritise when choosing their medicines. This should take the person's needs and circumstances into account, as outlined in recommendation 1.1.1 and in NICE's guideline on multimorbidity. See NICE's guideline on shared decision making for guidance on how to do this effectively.
Involving people in medicine discussions
To support a personalised diabetes management plan, the potential benefits and possible harms of medicines should be discussed with the person (see recommendation 1.9.2 in NICE's guideline on type 2 diabetes in adults), alongside dietary advice and other aspects of healthy living, such as increasing physical activity. See the NHS Type 2 diabetes Path to Remission Programme and NHS Better Health website for more information on how to achieve this.
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