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July 2016: Recommendation 138 has been reworded to clarify the role of GPs in referring people for eye screening and also to add information on when this should happen.
Excerpt
Type 1 diabetes affects over 370,000 adults in the UK, representing approximately 10% of adults diagnosed with diabetes. Given the complexity of its treatment regimens, successful outcomes depend, perhaps more than with any other long-term condition, on full engagement of the adult with type 1 diabetes in life-long day-by-day self-management. In order to support this, the health service needs to provide informed, expert support, education and training as well as a range of other more conventional biomedical services and interventionsfor the prevention and management of long term complications and disability.
The number of adults with type 1 diabetes means that, while the condition is certainly not rare, it is not common enough to provide and maintain all the necessary skills in its management for all healthcare professionals who will deal with it. The aim of this guideline is, therefore, to provide evidence-based, practical advice on the steps necessary to support adults with type 1 diabetes to live full, largely unrestricted, lives and avoid the acute and long-term complications of both the disease and of its treatment. NICE last produced such a guideline in 2004. The present guideline is an update of many sections of that guideline, focusing on areas where new knowledge and new treatment opportunities have arisen in the last decade. There have been many such developments, resulting in improving outcomes for adults with type 1 diabetes, but also presenting more challenges in the diversity and complexity of the tools they now have to achieve these outcomes.
Contents
- Guideline development group members
- NCGC technical team members
- Expert adviser
- Acknowledgements
- 1. Introduction
- 2. Development of the guideline
- 3. Methods
- 4. Guideline summary
- 5. Diagnosis
- 5.1. Introduction
- 5.2. Review question: In adults with diabetes, what is the best marker (C-peptide plus or minus antibodies) to distinguish between a diagnosis of type 1 diabetes, type 2 diabetes and other forms of diabetes?
- 5.3. Clinical evidence
- 5.4. Economic evidence
- 5.5. Evidence statements
- 5.6. Recommendations and link to evidence
- 5.7. Research recommendation
- 6. Care process and support [2004]
- 7. Education programmes and self-care
- 8. Blood glucose control
- 9. Insulin therapy
- 10. Referral for islet or pancreas transplantation
- 11. Impaired awareness of hypoglycaemia [2015]
- 12. Ketone monitoring and management of diabetic ketoacidosis (DKA)
- 13. Associated illness [2004]
- 14. Arterial risk control
- 15. Inpatient management
- 16. Management of complications
- 16.1. Eye disease [2004]
- 16.2. Diabetic kidney disease: kidney damage [2004]
- 16.3. Chronic painful diabetic neuropathy [2004]
- 16.4. Autonomic neuropathy [2004]
- 16.5. Gastroparesis [2015]
- 16.6. Acute painful neuropathy of rapid glycaemic control [2015]
- 16.7. Diabetes foot problems [2004]
- 16.8. Erectile dysfunction [2015]
- 16.9. Thyroid disease -frequency of monitoring [2015]
- 16.10. Psychological problems [2004]
- 16.11. Eating disorders [2004]
- 16.12. Management of special situations [2004]
- 17. Reference list
- 18. Acronyms and abbreviations
- 19. Glossary
- Appendices A – F
- Appendix G. Clinical evidence tables
- Appendices H-U
- Appendix H. Economic evidence tables
- Appendix I. GRADE tables
- Appendix J. Forest plots
- Appendix K. Excluded clinical studies
- Appendix L. Excluded economic studies
- Appendix M. Network meta-analysis: long-acting insulin
- Appendix N. Cost-effectiveness analysis: Long-acting insulin and insulin regimen
- Appendix O. Cost-effectiveness analysis - HbA1c threshold
- Appendix P. Cost-effectiveness analysis – Continuous glucose monitoring (CGM) versus standard monitoring of blood glucose (SMBG)
- Appendix Q. Unit costs
- Appendix R. Research recommendations
- Appendix S. Removed text from CG15
- Appendix T. Changes to recommendations from 2004 guideline
- Appendix U. NICE technical team
- References
Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.
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