Transcript Using this template - NICE | The National Institute for

Type 2 diabetes
Implementing NICE guidance
2009
NICE clinical guideline 87
Updated guidance
This guideline updates and replaces:
• key sections on drugs to lower blood glucose in ‘Type 2 diabetes:
the management of type 2 diabetes’ (NICE clinical guideline 66, 2008)
•NICE guidelines on retinopathy, renal disease, blood glucose, and
blood pressure and blood lipids in type 2 diabetes (NICE inherited
clinical guidelines E, F, G and H, 2002)
Recommendations on type 2 diabetes in guidance on:
•long-acting insulin analogues (NICE technology appraisal guidance
53, 2002)
•patient-education models for diabetes (NICE technology appraisal
guidance 60, 2003)
•glitazones (NICE technology appraisal guidance 63, 2003)
What this presentation covers
Scope
Key priorities for implementation
Costs and savings
Discussion
Find out more
Scope
This guideline covers the care of people with diagnosed
type 2 diabetes in primary, secondary or tertiary care.
It does not cover specialist tertiary procedures in areas
such as vascular surgery, renal medicine, cardiology and
ophthalmology, and the care of pregnant women.
Patient education
Offer structured education to every person and/or
their carer at and around the time of diagnosis.
Review and reinforce this annually.
Inform people and their carers that structured
education is an integral part of diabetes care.
Non-pharmacological
management – dietary advice
Provide individualised and ongoing nutritional
advice from a healthcare professional with specific
expertise and competencies in nutrition.
Setting a target glycated
haemoglobin (HbA1c)
Involve the person with diabetes in setting their
individual targets.
Encourage maintenance of individual target unless
quality of life is impaired.
Avoid pursuing highly intensive management to levels of
less than 6.5%.
Offer lifestyle advice and medication to help people
maintain individual targets.
Self-monitoring
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 the purpose and
agree how it should be
interpreted and acted upon.
Starting insulin therapy
When other measures no longer achieve adequate
blood glucose control, discuss the benefits and risks of
insulin therapy.
When starting insulin therapy, use a structured
programme employing active insulin dose titration.
Cardiovascular risk estimation
Perform a full lipid profile when assessing cardiovascular
risk after diagnosis and annually, and before starting
lipid-modifying therapy.
If the person is considered not to be at high
cardiovascular risk, estimate cardiovascular risk
annually.
Costs and savings –
recommendations with
significant cost impact
• Use of DPP-4 inhibitors (sitagliptin, vildagliptin)
• Use of thiazolidinediones (pioglitazone, rosiglitazone)
• Use of a GLP-1 mimetic (exenatide)
Discussion
In what ways do we need to update our existing
protocols?
How do we deliver patient education for people newly
diagnosed with diabetes and how do we follow them up?
What is our current policy on self-monitoring of blood
glucose and how does that need to change across
primary and secondary care?
Find out more
Visit www.nice.org.uk/CG87 for:
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the NICE guideline
the quick reference guide
‘Understanding NICE guidance’
costing report and template
audit support