NICE targets tight blood sugar control in new diabetes guidelines
pharmafile | August 27, 2015 | News story | | NICE, NICE guidelines, Public Health England, Type 1 diabetes, diabetes
NICE has urged healthcare professionals to target tighter blood sugar control, in a suite of recommendation in updated guidelines on the management of diabetes in children and adults.
The three NICE guidelines cover type 1 diabetes in adults, type 1 and 2 diabetes in children and young people and diabetic foot problems.
The guidelines recommend support to help adults with type 1 diabetes to aim for a target HbA1c level of 48 mmol/mol (6.5%) or lower, to minimise their risk of long-term vascular complications
The updated guidelines offer all adults with type 1 diabetes a structured education programme on dose-adjustment for normal eating and to support adults for a target glycated haemoglobin level to minimise the risk of long-term vascular complications. The guideline will also offer multiple daily injection basal–bolus insulin regimens, rather than twice-daily mixed insulin regimens.
Recommendations on managing type 1 and type 2 diabetes in children and young people include referring children and young people with suspected type 1 diabetes immediately whilst offering ongoing real-time continuous glucose monitoring whilst continuing a programme of education for them and their families.
It came as a report by Public Health England found that up to five million people in England are at risk of developing type-2 diabetes. And NHS figures show that type 1 diabetes affects more than 370,000 adults in the UK.
Sir Andrew Dillon, NICE chief executive says: “There are over 3 million people with diabetes in the UK. Around 10% have type 1 diabetes and 90% have type 2 diabetes. Diabetes is a long-term condition that has a serious impact on people who live with it. Everyone with the condition needs access to support and information, so that their condition can be managed successfully.
“The standard of diabetes care varies across the NHS. These updated guidelines are designed to help more people to receive the best treatment and support. They recommend effective and cost effective care and advice to NHS organisations on such things as setting up specialist services to reduce risk of diabetes-related amputation. Implementing these recommendations will help prevent serious illnesses linked to diabetes.”
Dr Julie Edge, consultant in paediatric diabetes at Oxford Children’s hospital and member of the group which developed the NICE guideline on diabetes in children and young people, says the target level will be ‘hard to achieve’, but adds: “Achieving tight control needs intensive insulin management from the time type 1 diabetes is diagnosed, which means multiple daily injections or insulin pump therapy.”
The guidelines also cover foot complications, which are common in people with diabetes with an estimate that 10% of people with diabetes will have a diabetic foot ulcer at some point in their lives. Mortality rates after diabetic foot ulceration and amputation are high, with up to 70% of people dying within five years of having an amputation and around 50% dying within five years of developing a diabetic foot ulcer.
Recommendation for foot complications state, if a person has a limb-threatening or life-threatening diabetic foot problem, they are to be referred immediately. Information should also be provided with clear explanations about the risk of developing a diabetic foot problems to people diagnosed with diabetes.
Yasmita Kumar
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