1. Type 2 diabetes Implementing NICE guidance 2009 NICE clinical guideline 87

2. 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)

3. What this presentation covers Scope Key priorities for implementation Costs and savings Discussion Find out more

4. 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.

5. 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. Patient education

6. Provide individualised and ongoing nutritional advice from a healthcare professional with specific expertise and competencies in nutrition. Non-pharmacological management – dietary advice

7. Setting a target glycated haemoglobin (HbA 1c ) 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.

8. 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.

9. 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.

10. 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.

11. 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)

12. 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?

13. Find out more Visit www.nice.org.uk/CG87 for: the NICE guideline the quick reference guide Understanding NICE guidance costing report and template audit support