Management of type 2 diabetes in adults: summary of updated NICE guidance (original) (raw)

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Management of type 2...
Management of type 2 diabetes in adults: summary of updated NICE guidance

Hugh McGuire, technical advisor1,
Damien Longson, guideline chair2,
Amanda Adler, consultant physician3,
Andrew Farmer, professor of general practice4,
Ian Lewin, consultant diabetologist5
on behalf of the Guideline Development Group
1National Institute for Health and Care Excellence, London, UK
2Manchester Mental Health and Social Care Trust, Manchester M21 9UN, UK
3Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
4University of Oxford, Oxford, UK
5Northern Devon Healthcare NHS Trust, Barnstaple EX31 4JB, UK
Correspondence to: H McGuire Hugh.McGuire{at}nice.org.uk

What you need to know

Glycaemic control is only one aspect of care of type 2 diabetes
Inform adults with type 2 diabetes at their annual review that setting an HbA1c target is their choice
Metformin remains the first line drug, unless it is contraindicated or not tolerated
Do not routinely offer self monitoring of blood glucose to all

New evidence and developments regarding the management of blood glucose levels, antiplatelet therapy, and erectile dysfunction prompted this update of the 2009 guidance. There were 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 combinations for licensed drugs, and the potential impact of drugs coming off patent on health and economic issues. New evidence and safety issues relating to the off label use of antiplatelet therapy (aspirin and clopidogrel) in the primary prevention of cardiovascular disease were also considered.

Type 2 diabetes affects 6% of the UK population1 and is commonly associated with obesity, physical inactivity, raised blood pressure, and disturbed blood lipid levels. It causes long term microvascular and macrovascular complications, plus reduced quality of life and life expectancy. The management of diabetes is complex and needs to address the prevention of cardiovascular disease and microvascular disease and the detection and management of early vascular complications.

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE),2 recently updated due to the availability of new evidence and developments. The article also summarises a selection of recommendations which still stand.

What’s new in this guidance

The suggested target level for HbA1c has been relaxed to ≤48 mmol/mol (≤53 mmol/mol if more than one drug is prescribed)
Separate medication pathway for those who are unable to take metformin
Do not give aspirin or clopidogrel for the …

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