The guidance was published following a review of 4 separate NICE guidelines on various aspects of diabetes management first introduced in 2002. These have been superseded by this new guidance.
KEY PRIORITIES FOR IMPLEMENTATION
- Offer structured education to all patients and/or carers at diagnosis, with annual reinforcement and
- Provide individualised and ongoing dietary advice from a healthcare professional with relevant expertise.
- Set a target HbA1c in partnership with the patient (this may be higher than the general target of 6.5%) and then:
- Encourage maintenance of the target unless side effects or efforts to achieve this impair quality of life.
- Offer therapy to help achieve and maintain target HbA1c.
- Advise those with a higher HbA1c of the benefits of any reduction towards the agreed target.
- Avoid pursuing highly intensive management to achieve HbA1c <6.5%.
- Offer self-monitoring of blood glucose to newly diagnosed patients only as an integral part of self management education.
- Use a structured programme when starting insulin therapy that employs active insulin dose titration. This should include structured education, telephone support, frequent self monitoring, dose titration to target, dietary understanding, management of hypoglycaemia and acute changes in plasma glucose control, and support from an experienced healthcare professional.
- Monitor HbA1c every 2-6 months (six-monthly once blood glucose and treatment are stable).
- Assess self-monitoring at least annually and in a structured way.
- Monitor BP annually if not hypertensive or with renal disease (repeat more often if over target).
- Review cardiovascular risk status annually.
- Monitor albumin:creatinine ratio, serum creatinine and GFR annually regardless of presence of nephropathy.
- Perform eye screening at diagnosis then annually.
- Conduct formal questioning about neuropathic symptoms (including erectile dysfunction in men) annually.
The guidance also provides treatment algorithms, covering blood glucose-lowering therapy, blood pressure management and management of symptomatic neuropathy.
The full guideline can be viewed on the NICE website.