NICE Guidelines for Diabetes: Management, Therapies, and More (2024)

Diabetes is a chronic condition that affects millions of people worldwide, and its prevalence continues to rise. It's only natural for people to have different opinions on managing diabetes.

However, when in doubt, you should always turn to medical authorities and clinical guidelines for the best advice on managing your diabetes.

The NICE guidelines for diabetes management are an excellent, reliable source whether you're a healthcare professional or a diabetic.

Today, we'll break down the NICE guidelines for diabetes and help you understand everything from diabetes management to therapies and more!

The NICE guidelines are a series of recommendations by the medical experts of the National Institute for Health and Care Excellence (NICE).

There's a NICE guideline for almost every medical condition or disease, including diabetes. Remember that the guideline development process can take years because it involves extensive research and evidence-based studies.

The NICE diabetes guideline covers the different aspects of diabetes care and management. It tells you how to manage your blood glucose levels, what medications your doctor might prescribe, and other crucial info you might need.

The recommendations in this guideline can help you manage your condition and, more importantly, manage or avoid complications.

You don't need to be a doctor or a pharmacist to use the NICE guidelines for diabetes. They're meant for anyone who needs information on managing their condition or taking care of others.

This can include:

• Healthcare professionals, such as physicians, diabetes educators, and nurses
• Adults with type 2 diabetes
• Families and carers of people with type 2 diabetes
• Local commissioners and providers

The NICE guidelines for diabetes include the following topics:

• Individualised care approach
• Monitoring blood glucose levels
• Dietary advice
• Managing blood pressure
• Diabetes therapy and medication
• Antiplatelet therapy (blood thinners)
• Anti-cholesterol therapy
• Managing and preventing complications

Let's break down each of these guideline topics into simpler terms.

The individualised care approach in the diabetes guidelines means there's no one-shoe-fits-all regarding type 2 diabetes. You must tailor each diabetes care plan to the patient's needs, preferences, and values.

For example, some people have other conditions that prevent them from taking insulin. Others might not be able to take oral diabetes medication because they can't swallow pills.

Some people have a needle phobia, which makes it difficult to take their insulin shots. Their doctor might suggest a needle-free injection device such as InsuJet to help them take their insulin doses without fear or pain.

Regarding managing your blood glucose levels, the guidelines have recommendations for blood sugar measurements.

This includes how often to measure your blood glucose levels, what blood test to do, and ideal ranges.

The most important test for gauging how well you're managing diabetes is the HbA1c test.

The HbA1c test, also known as the glycated haemoglobin test, is a blood test that measures the average amount of sugar in your blood over the past 2-3 months. More specifically, it measures how much sugar is stuck to the hemoglobin of your red blood cells.

If your diabetes is uncontrolled, you have more sugar in your blood over time, which results in a higher HbA1c test result. If your HbA1c result is 6.5% or higher, it means you have diabetes.

If it's between 5.7% and 6.4%, you might get diabetes soon. And if it's lower than 5.7%, your blood sugar is under control.

As a diabetic, the higher your score is, the worse your diabetes control.

The NICE guidelines recommend taking the HbA1c test every 3-6 months until you get stable results. This will mean your medication, diet, and lifestyle habits are working, and you're managing your condition well.

Once your blood glucose levels are stable, you can take the HbA1c test once every 6 months just to be safe.

A healthy, well-balanced diet can help improve your diabetes and other conditions. 

Here are some of the dietary recommendations in the NICE guidelines:

• More Whole Foods: Focus on whole, unprocessed foods like vegetables, fruits, whole grains, lean proteins, and healthy fats.
• Low-Glycemic-Index Foods: Choose low-glycemic-index foods, which are digested slowly and won't cause a sudden spike in blood sugar levels.
• Avoid Unhealthy Snacks: Limit unhealthy snacks that are full of added sugars, refined carbohydrates, and saturated fats. Swap them for healthy snacks such as nuts, seeds, and fruit.
• Low-fat Dairy: Stick to low-fat dairy products such as low-fat yoghurt and skimmed milk.
• Don't Skip Meals: Eat regular meals to keep your blood sugar levels stable.
• More Fibre: Opt for high-fibre foods, which can help slow down digestion and absorption of carbohydrates.
• More Protein: Select lean protein sources, like poultry, fish, and legumes, instead of processed meats.
• Carb Counting: Keep track of your carbohydrate intake and adjust accordingly based on your blood sugar levels.
• Limit Saturated and Trans Fatty Acids: Avoid frying foods since this increases your unhealthy fat intake. Instead, choose cooking methods like grilling, roasting, or steaming.
• More Healthy Fats: Include healthy fats, such as avocado, olive oil, and nuts in your diet.
• More Whole Grains: Stick to foods that contain whole grains such as oats and quinoa, which are also rich in protein, nutrients, and multivitamins

Being obese or overweight can be detrimental to your diabetes progress. It makes you more susceptible to other diseases and diabetes-related complications.

NICE and Diabetes UK guidelines show the importance of healthy weight loss for type 2 diabetics.

They explain that just losing about 5-10% of your body weight can have profoundly positive effects on your diabetes management.

For example, if you weigh 300 lbs, you should aim to lose at least 15 pounds. However, if this target is too difficult at first, you can still benefit from any weight loss, so don't be discouraged.

Monitoring and managing your blood pressure is crucial if you have type 2 diabetes.

Having stable blood pressure decreases your cardiovascular risk, which means you're less likely to suffer from heart disease, strokes, and other life-threatening conditions.

It also prevents complications such as kidney disease, eye problems, adverse events related to high blood sugar, and blood vessel diseases.

Interestingly, diabetes and high blood pressure have a sort of chicken-and-egg situation. High blood pressure can make your diabetes worse and uncontrolled diabetes in adults can lead to high blood pressure.

This is why managing your blood pressure positively affects your diabetes treatment and vice versa.

While normal blood pressure is typically about 120/80 mmHg, the NICE guidelines recommend a target blood pressure of 130/80 mmHg for adults with type 2 diabetes.

To achieve this blood pressure, you'll need to combine a balanced diet, regular exercise, healthy lifestyle changes, and possibly blood pressure medication.

Your doctor might prescribe ACEI (angiotensin-converting enzyme inhibitors) or A2RBs (angiotensin-2 receptor blockers) to help lower your blood pressure.

The second line of treatment is thiazide diuretics and CCBs (calcium channel blockers) if the former drugs don't work.

The NICE guideline recommends monitoring your blood pressure regularly to determine if your medicine works and following up with your healthcare provider every month or two.

Regarding diabetes medication, the NICE guidelines help healthcare providers decide which medicines to give first.

This is usually based on blood tests, how responsive you are to previous diabetes medications, and how well your blood glucose is under control.

The guidelines for diabetes therapy follow a ladder-like approach where you try the medicine on the first rung, and if that doesn't work, you try the second rung and so on.

Generally speaking, your doctor might prescribe either insulin, oral diabetes medication, or both.

Contrary to popular belief, not everyone who has diabetes gets prescribed insulin right away.

Sure, type 1 diabetics might need lifelong insulin since their childhood, but millions of people with type 2 diabetes lead a perfectly healthy life without insulin. It all depends on how responsive you are to your diabetes medication and dietary, exercise, and lifestyle habits.

However, don't worry if you're prescribed insulin. It's extremely easy to use. Several options are from the traditional needle and syringe to insulin pumps and needle-free jet injectors like InsuJet.

The most important thing to remember with insulin is to take the correct dose at the correct time. Also, rotating the injection site is vital so your skin doesn't get irritated from repeated pricks in the same place.

More importantly, keep in mind that insulin types are not interchangeable. You should never switch to a different insulin type or brand without consulting your physician or diabetes care team.

They will likely use the Medicines and Healthcare Products Regulatory Agency (MHRA) guidelines for switching between insulins to extrapolate the right dose for you.

Here are some of the most common diabetes medications, besides insulin, you might encounter:

• Biguanides: Lower blood sugar by reducing glucose production in the liver and increasing insulin sensitivity. The most popular example is metformin (Glucophage).
• DPP-4 Inhibitors: Protect a natural hormone in your body called incretin, which encourages insulin production. Examples include alogliptin, linagliptin, saxagliptin, and sitagliptin.
• GLP-1 Receptor Agonists: Mimic the action of the incretin hormone, encouraging insulin production and lowering blood sugar. Examples include: semaglutide, liraglutide, exenatide
• SGLT2 Inhibitors: Encourage the kidneys to eliminate excess glucose through urine, lowering blood sugar levels. Examples include: canagliflozin, dapagliflozin, empagliflozin
• Insulin Secretagogues (Sulfonylureas): Stimulate the pancreas to produce more insulin. Examples include: glimepiride, repaglinide
• TZDs: Improve insulin sensitivity and reduce glucose production in the liver. Examples: pioglitazone, rosiglitazone

When it comes to treating diabetes, the first and most important rung on the ladder is lifestyle changes. They can be enough to improve your blood sugar, and you might not need any medications whatsoever!

However, in most cases, your doctor will likely move on to the next rung on the ladder, metformin, just to be safe.

Metformin is one of the simplest and most basic diabetes medications your doctor might initially prescribe. It helps your body handle excess blood sugar and improves insulin sensitivity.

If your blood sugar still isn't under control, the next step is to add a sulfonylurea drug to try and get your pancreas to pump out more insulin.

If that still doesn't work, the next step would be to add a TZD drug or insulin doses. This is usually the highest number of diabetes medications your doctor will prescribe simultaneously.

However, taking so many medications simultaneously, such as the metformin + sulfonylurea+ insulin combo, might work so well that your blood sugar drops too low (hypoglycemia). If this happens, NICE recommends stopping the sulfonylurea and continuing with just the metformin and insulin.

After that, if your blood sugar levels are still high or unstable, you can just adjust your insulin doses and that should fix things.

In summary, here's how the metaphorical ladder of treatment would look step by step:

1. Step 1: Lifestyle changes
2. Step 2: Start with Metformin
3. Step 3: Add Sulfonylurea
4. Step 4: Add TZD or insulin
5. Step 5: Remove sulfonylurea if blood sugar is too low
6. Step 6: Adjust insulin doses according to blood sugar

According to the NIH (National Institutes of Health, people with type 2 diabetes are twice as likely to develop cardiovascular diseases. This has led many healthcare providers to regularly prescribe antiplatelet therapy or blood-thinning medication, such as aspirin or clopidogrel.

However, the NICE guidelines recommend that you first assess whether there's a risk of cardiovascular disease. If not, there's no need to prescribe aspirin or clopidogrel.

Here are some of the most common indications that you're at risk of cardiovascular disease (CVD):

• Age: Your risk of CVD increases as you get older, with men over 45 and women over 55 being at higher risk.
• Gender: Men are generally at greater risk of CVD than women, although the risk for women increases after menopause.
• Family history: If you have a family history of CVD, such as a parent or a sibling, you're more likely to develop CVD.
• Smoking: Smoking is a major risk factor for CVD
• High blood pressure: Uncontrolled high blood pressure can damage your arteries, increasing your risk of CVD.
• High cholesterol: Having high levels of low-density lipoprotein (LDL) cholesterol, also known as bad cholesterol, can increase your risk of CVD.
• Obesity: Being obese or overweight can increase your risk of CVD, as it raises your blood pressure, cholesterol levels, and risk of diabetes. Healthy weight loss can improve your diabetes and lower your risk.
• Stress: Chronic stress can increase your risk of CVD, as it raises your blood pressure and contributes to other risk factors.
• Alcohol consumption: Heavy alcohol consumption can increase your blood pressure, risk of CVD, triglycerides, and risk of heart failure.

People with type 2 diabetes, especially those who are obese or overweight, are more likely to develop high cholesterol levels. This risk also increases with age, especially in people over 40.

This is why the NICE guidelines recommend cholesterol-lowering medications to almost all type 2 diabetics over 40 years old.

Your doctor will usually start you on 40mg of simvastatin and monitor your lipid profile. If your LDL (bad cholesterol) rises, they'll either increase your dose to 80 mg daily or add another cholesterol drug.

The NICE guidelines also focus on preventing common diabetes complications such as chronic kidney diseases and eye damage.

One major concern for individuals with diabetes is the risk of developing chronic kidney disease (CKD). The NICE guidelines emphasize the importance of early detection and management of CKD.

They recommend regular monitoring of kidney function through tests such as estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR).

Also, look out for signs and symptoms of urinary tract infections, which are familiar with uncontrolled diabetes and CKD.

The NICE guidelines also focus on preventing eye damage, a common complication of diabetes known as diabetic retinopathy. This can range from blurred vision to glaucoma and complete vision loss!

NICE recommends annual dilated eye exams to ensure the high blood sugar hasn't damaged the nerves going to your eyes.

The NICE guidelines for diabetes are a game-changer for healthcare professionals, patients, and their families.

These updated recommendations offer a comprehensive roadmap for managing type 2 diabetes and avoiding its complications.

From lifestyle modifications to cutting-edge medication and insulin therapies, NICE guidelines have you covered!