Type 1 diabetes can, if poorly controlled, produce devastating problems in both the short and the long term. Good control of blood glucose levels reduces the risk of these problems arising, but can be very difficult for patients and carers to achieve. This guideline emphasises that the NHS should provide all patients with the means – and the necessary understanding – to control their diabetes, and that it should help patients integrate the disease management with their other activities and goals. It argues that every person with diabetes should be able to develop their own care plan and utilise effective treatment in a way agreeable to them. The input of various health professionals may be needed to achieve this, and should be readily available. A system of regular monitoring, so that any complications which do develop are picked up at an early stage and treated appropriately, should also be provided.

In common with all NICE guideline recommendations, those for Type 1 diabetes have been developed using a rigorous, evidence-based methodology. An extensive search identified the relevant medical literature, and papers were carefully assessed to ensure that recommendations were based on treatment and practice of proven benefit. This process was carried out by a guideline development group (GDG), a small team from the NCC-CC working together with patients and health professionals with wide expertise in Type 1 diabetes. They have used the available evidence to produce guidance that is clinically relevant as well as methodologically sound. The availability of clinical expertise also allowed recommendations to be made in areas for which there is inadequate evidence, but which are important to patients and carers. At the same time the need for further research in these areas was indentified.

Contents

• Acknowledgements
• Membership of development groups
• Preface
• Glossary
• The development of the guideline
  • 1. Introduction
    • 1.1 Definition
    • 1.2 Health and resource burden
    • 1.3 Scope
    • 1.4 Other relevant work
  • 2. Methodology
    • 2.1 Aims and principles
    • 2.2 The developers
    • 2.3 Searching for the evidence
    • 2.4 Synthesising the evidence
    • 2.5 Health economic evidence
    • 2.6 Drafting recommendations
    • 2.7 Agreeing recommendations
    • 2.8 Writing the guideline
    • 2.9 Structure of the guideline
  • 3. Key messages of the guideline
    • 3.1 Key recommendations
    • 3.2 An outline Type 1 diabetes care algorithm
    • 3.3 Audit criteria
• The guideline
  • 4. Diagnosis
    • 4.1 Rationale
    • 4.2 Evidence
    • 4.3 Comment
    • 4.4 Consideration
  • 5. Care process and support
    • 5.1 Scope of this chapter
    • 5.2 Optimal healthcare processes
    • 5.3 Support groups
    • 5.4 Quality audit and monitoring
  • 6. Education progammes and self-care
    • 6.1 Education programmes for adults with Type 1 diabetes
    • 6.2 Self-monitoring of blood glucose
    • 6.3 Dietary management
    • 6.4 Physical activity
    • 6.5 Cultural and individual lifestyle
  • 7. Blood glucose control and insulin therapy
    • 7.1 Clinical monitoring of blood glucose
    • 7.2 Glucose control assessment levels
    • 7.3 Insulin regimens
    • 7.4 Insulin delivery
    • 7.5 Hypoglycaemia: prevention of hypoglycaemia, problems related to hypoglycaemia and management of symptomatic hypoglycaemia
  • 8. Arterial risk control
    • 8.1 Identification of arterial risk
    • 8.2 Interventions to reduce risk and to manage arterial disease
    • 8.3 Blood pressure
  • 9. Management of late complications: diabetic eye disease
    • 9.1 Retinopathy surveillance programmes
    • 9.2 Screening tests for retinopathy
    • 9.3 Referral
    • 9.4 Non-surgical treatment of diabetic retinopathy
  • 10. Management of late complications: diabetic kidney disease
    • 10.1 Kidney damage
  • 11. Management of late complications: diabetes foot problems
    • 11.1 Screening and surveillance of diabetic foot problems
    • 11.2 Management of foot ulceration and associated risk factors
  • 12. Management of late complications: diabetes nerve damage
    • 12.1 Diagnosis and management of erectile dysfunction
    • 12.2 Diagnosis and management of autonomic neuropathy
    • 12.3 Optimum management of painful neuropathy
  • 13. Management of special situations
    • 13.1 Adults who are newly diagnosed
    • 13.2 Diabetic ketoacidosis
    • 13.3 Inpatient management
    • 13.4 Associated illness
    • 13.5 Psychological problems
    • 13.6 Eating disorders
  • 14. Areas for future research
    • Priority areas
    • Other areas
• Appendices
  • Appendix A Clinical questions and search strategies
  • Appendix B Unlicensed medicines
  • Appendix C The scope of the guideline
  • Appendix D Evidence tables
• References