The National Institute of Health and Care Excellent (NICE) believes healthcare professionals should involve patients with type 2 diabetes in decision about aspects of their care, such as blood sugar management.
NICE’s new guidelines – “Type 2 diabetes in adults: management” – were published on Wednesday 2 December, and have stressed the need for individualising care for type 2 diabetes patients.
These updated guidelines on type 2 diabetes in adults are NICE’s first since 2009, and they call for healthcare professionals to consider a person’s personal preferences, comorbidities, risks from polypharmacy (the use of four or more medications) and their ability to benefit from long-term interventions because of reduced life expectancy. NICE also recommends offering structure education to patients and their family or carers around the time of diagnosis.
NICE stresses that a patient’s personal circumstances should be reassessed at each review and medicines could be ceased if they are not effective.
HbA1c
NICE also says patients should be encouraged to hit their HbA1c target, unless it results in adverse effects, such as hypoglycemia. Patients should do more physical activity and try to obtain a normal BMI as part of the recommended lifestyle changes to achieve this.
HbA1c levels should be measured at 3-6 monthly intervals until they are stable or six-monthly intervals once a patient’s HbA1c and glucose-lowering therapy are stable.
If a patient’s HbA1c is not adequately controlled by a single drug and rises to 58 mmol/mol (7.5 per cent) or higher, healthcare professionals should:
reinforce advice about diet, lifestyle and adherence to drug treatment
support the person to aim for an HbA1c level of 53 mmol/mol (7.0%)
intensify drug treatment
Drug treatment
NICE has specified standard-release metformin as the initial drug treatment option for adults with type 2 diabetes. The guidelines also include an algorithm to help clinicians make decisions on the best drug options for blood glucose-lowering therapy.
Dr Amanda Adler, consultant diabetologist and member of the NICE guideline development group, said: “This update to the guideline for type 2 diabetes is good news for people with type 2 diabetes and for health professionals given the many therapies now available.
“The guideline comprehensively covers the best care for patients with type 2 diabetes taking into account effectiveness of medications, enhancing quality of life, and wisely using NHS resources.”

Dr Ian Lewi, NICE guideline developer and retired consultant endocrinologist, added: “The guideline highlights that putting people with type 2 diabetes at the centre of their care package is essential. For example the guideline recommends that adults with type 2 diabetes should be involved in decisions about their individual HbA1c target – the average amount of glucose in their blood over 2 to 3 months.
“Health professionals are also advised to individualise recommendations for carbohydrate intake and alcohol intake, and meal patterns. All of these steps should result in improved outcomes for adults with type 2 diabetes – reduced complications and better health.”

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