NICE has finally published a long-awaited update to its guideline on the treatment and management of type II diabetes, with a new focus on an individualised approach to secure the best outcomes for patients.

The previous version had come under fire from all sides for its apparent focus on cost over care, with many experts voicing concern over patient safety and warning of confusion in primary care.

Now the update is focused on tailoring advice and treatments to individual circumstances, including whether the patient has any co-existing illnesses, with regular reviews, and also highlights the importance of “structured education” to help improve self-management of the condition. 

The Institute has updated its recommendations on blood glucose management to give a clearer picture of the sequence of drug treatments to offer, an has included an algorithm in the guideline to help clinicians select appropriate therapy. 

Adults with type II diabetes should be involved in decisions about their individual HbA1c target, it said, which should be measured every three to six months until stable on unchanging therapy, and at six-monthly intervals thereafter.

Blood pressure should be checked every one to two months, and therapy ramped up if the person is already on antihypertensive drug treatment, until blood pressure is consistently below 140/80 mmHg (or 130/80 mmHg if there is kidney, eye or cerebrovascular damage).

The Association of the British Pharmaceutical Industry says the updated guidance is “great news” for patients. 

“We believe these guidelines now represent ‘one voice’ from the diabetes community - doctors, patient groups, science leaders and the pharmaceutical industry - and this can only be positive,” noted its head of medical affairs, Jacintha Sivarajah.

MSD has also welcomed guideline, particularly as it now places dipeptidyl peptidase-4 inhibitors on an equal footing with other first intensification treatments and recognises the need for a tailored approach. 

“The revised guideline is more in line with the NHS and the Department of Health’s focus on medicines optimisation, with the aim of helping patients to make the most of medicines,” noted David Millar-Jones, GP and Chair of the Primary Care Diabetes Society.   

Preventing complications

“Following these evidence-based recommendations will enable health professionals to create individual packages of care to prevent serious illnesses linked to diabetes,” said NICE chief executive Sir Andrew Dillon, adding that the Institute has “plans in place to establish a standing subcommittee on diabetes within its guideline updates programme,” to keep pace with new developments in care. 

But while largely welcoming the new guidelines, Diabetes UK argues that, even with solid evidence, “NICE is still continuing to wait far too long before making changes to the guidelines that could benefit patients”.

“We are calling on NICE to commit to on-going updates so that people with type II diabetes can benefit from latest advances in medication and diabetes care,” said Chris Askew, the charity’s chief executive, and urged the Institute “to go ahead and set up the proposed standing committee to enable a far more rapid update of reputable diabetes guidance”. 

“Up-to-date guidelines will enable generalist practitioners to support people with diabetes to manage their condition far better, so they can reduce their risk of developing devastating complications,” he noted, and also called on CCGs and healthcare professionals “to increase access to diabetes education and appropriate blood glucose monitoring to help with self-management”.