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NICE recommends tighter blood sugar control in diabetes

NICE issues updated guidance on managing type 1 diabetes in adults and type 1 and 2 in children and adolescents

Ingrid Torjesen

Wednesday, 26 August 2015

Blood sugar levels need to be managed more tightly in diabetes to minimise the risk of long-term vascular complications says the National Institute for Health and Care Excellence which issued a series of guidelines today on managing the condition.

An updated NICE guideline on diagnosing and managing type 1 diabetes in adults recommends a target HbA1c level of 48 mmol/mol (6.5%) or lower. The same target is also recommended for children and young people with either type 1 or type 2 diabetes, in an updated guideline specifically on the management of the condition in this age group. The previous recommendation was that most patients were treated to a 7.5% target.

Sir Andrew Dillon, NICE chief executive, said: “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.”

Professor Stephanie Amiel, professor of diabetic medicine at King’s College London and chair of the NICE group which developed the type 1 guideline, said: “Currently most adults with type 1 diabetes do not maintain the average amount of glucose in their blood (HbA1c) associated with fewer complications: life expectancy is reduced by over ten years and rates of kidney failure have increased.”

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, said that it was the first to recommend in this age group attempting to reach an HbA1c level near the normal range and nearly normal daily blood glucose readings. “Because the ideal HbA1c target level of 48 mmol/mol (6.5%) or lower is hard to achieve, it is important that children and young people do not feel pressurised, and individual targets are discussed,” she said.

Barbara Young, chief executive of the charity Diabetes UK, said: “Meeting the new blood glucose targets can bring about inherent health benefits. However, the government needs to ensure that appropriate support is available to help children and their families to achieve this. We know that the majority of children with type 1 diabetes already struggle to achieve current blood glucose targets with the most recent figures revealing that less than one in five manage this.”

The updated guidelines say that children and young people and their families should be offered a continuing programme education from a diagnosis of diabetes and that adult patients should be offered a structured education programme, such as DAFNE (dose-adjustment for normal eating) programme, 6–12 months after diagnosis.

Children and young people with type 1 diabetes who have frequent severe hypoglycaemia or impaired awareness of hypoglycaemia that may be associated with adverse consequences, such as seizures or anxiety, should be offered ongoing real-time continuous glucose monitoring with alarms. The insulin injection regimen of choice offered to all adults with type 1 diabetes should be multiple daily injection basal–bolus insulin regimens, rather than twice-daily mixed insulin regimens.

An updated guideline on managing type 2 diabetes in adults is due to be published before the end of the year.

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