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Updated NICE guidelines on the management of type 2 diabetes

The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Chronic Conditions (NCC-CC) have today issued updated guidance on the management of type 2 diabetes. The new guideline replaces existing NICE recommendations for the condition, revising areas where new information has become available, and will act as a single reference point for healthcare professionals on all aspects of the care and support that should be offered to people with type 2 diabetes.
The new guidance recommends that people with type 2 diabetes should receive structured and ongoing education from when they are first diagnosed, in order to help them understand and manage their condition. It also recommends that healthcare professionals should provide patients with information about a range of key issues including how best to keep glucose levels under control, how people can make sure they are safe to carry out normal activities such as driving, and individualised dietary advice so that people can make decisions that will keep them healthy.
Key recommendations are:

  • Offer structured education to every person and/or their carer at and around the time of diagnosis - this can be in group sessions run by people who have been specially trained to do this.
  • Provide individualised and ongoing nutritional advice from a healthcare professional with specific expertise and competencies in nutrition.

When setting a HbA1c target:

  • Involve the person in decisions about their individual HbA1c target level, which may be above that of 6.5% set for people with type 2 diabetes in general.
  • Encourage the person to maintain their individual target unless the resulting side effects (including hypoglycaemia) or their efforts to achieve this impair their quality of life.
  • Offer therapy (lifestyle and medication) to help achieve and maintain the HbA1c target level.
  • Inform a person with a higher HbA1c that any reduction in HbA1c towards the agreed target is advantageous to future health.
  • Avoid pursuing highly intensive management to levels of less than 6.5%.
  • Offer self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education. Discuss its purpose and agree how it should be interpreted and acted upon.

People who agree to start insulin therapy should be given:

  • Education about how to use the insulin and the injection device prescribed, how insulin works, how it affects the body and how you need to think about and control what you eat and drink.
  • Information about hypoglycaemia, how to best avoid it and what to do if it happens.
  • Equipment to check blood glucose levels, and how to get helpful results and how to use them.
  • Support (on the phone and face-to-face) from a doctor or nurse with training and experience in managing insulin therapy.

Kathryn Leivesley, specialist nurse and guideline development group member says: "Being diagnosed with diabetes can throw up questions about how it fits into your lifestyle - from how it makes you feel to managing diabetes when you are exercising. Although there's no known drug to cure the condition, clinicians can provide important practical help to individuals - for example, advice on how to ensure they are getting accurate and helpful blood glucose results. By putting a structured education programme in place, people with the condition and their carers will have access to good information when they need it most - this will mean they feel more confident in managing their condition."

The guidance is available at

Do you welcome these new guidelines? Your comments: (Terms and conditions apply)

"Yes. I work as a psychosexual therapist and diabetes is often linked with erectile dysfunction. A clear approach is vital to manageing the condition." - Tim Norton, Clinical Nurse Specialist