This guideline covers the care and management of type 2 diabetes in adults (aged 18 and over). It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications.

Contents

• Summary Section
  • GDG membership and ICG technical team
  • Strength of recommendations
  • Key Priorities for Implementation
  • Algorithm for blood glucose lowering therapy
  • Recommendations
  • Research recommendations
• Overview
  • Introduction
  • Prevalence
  • Health and resource burden
  • Reasons for the update
  • Medicines
  • Patient-centred care
• Methods
  • Population
  • Outcomes
  • Data extraction
  • Data imputation
  • Crossover trials
  • Evidence synthesis
  • Quality assessment
• Education
  • Structured education
• Lifestyle and non-pharmacological management
  • Dietary advice
• Blood pressure therapy
  • Clinical introduction
  • Blood pressure lowering – targets and intervention levels
  • Blood pressure lowering medications
• Antiplatelet therapy for primary prevention of cardiovascular disease
  • Clinical introduction
  • Evidence to recommendations
  • Recommendations and research recommendations
• Blood glucose management
  • Optimal target values for blood glucose measures
  • Intensive and conventional blood glucose targets
  • Self-monitoring of blood glucose
  • Drug treatment to control blood glucose
  • Long-term serious adverse effects of blood glucose lowering drug treatments
• Managing complications
  • Autonomic neuropathy
  • Nerve damage
  • Erectile dysfunction
  • Eye disease
• Reference
• Glossary and Abbreviations
• Appendices
  • Appendix A. Guideline Development Groups & Declarations of Interest
  • Appendix B. Scopes for NICE clinical guideline update 2015, NICE clinical guideline 87 & NICE clinical guideline 66
  • Appendix C. Search strategies and review protocols
  • Appendix D. GRADE tables and meta-analysis results
  • Appendix E. Evidence Tables
  • Appendix F. Full Health Economics Report
  • Appendix G. NICE Clinical Guideline 66 Deleted Text
  • Appendix H. Deleted text appendix - Type 2 diabetes: newer agents
  • Appendix I. Deleted appendix documents: NICE short clinical guideline 87 – Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes
  • Appendix J. Network meta-analyses results and input data for clinical evidence review of blood glucose lowering treatments
  • Appendix K. WinBUGS code
  • Appendix L. Excluded studies

Final version

August 2019: The section on blood pressure therapy was updated and replaced by the NICE guideline on hypertension in adults. Recommendations on blood pressure therapy have been removed.

April 2016: Text on sodium–glucose cotransporter 2 (SGLT-2) inhibitors was added to the section on initial drug treatment. The algorithm for blood glucose lowering therapy in adults with type 2 diabetes was also updated to revise footnote b with links to relevant NICE guidance on SGLT-2 inhibitors, and new information on SGLT-2 inhibitors was also added to the box on action to take if metformin is contraindicated or not tolerated.

July 2016: Recommendation 89 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. Minor corrections to project team lists.

December 2016: The algorithm for blood glucose lowering therapy in adults with type 2 diabetes was updated to include reference to NICE TA418 on dapagliflozin in triple therapy for treating type 2 diabetes.

Minor changes since publication

June 2018: Recommendation 1.3.11 was added to the short version to provide a link to NICE’s advice on bariatric surgery. This change can be seen in the short version of the guideline (https://www.nice.org.uk/guidance/NG28).

January 2018: Footnotes were added with links to MHRA warnings about sodium–glucose cotransporter 2 (SGLT-2) inhibitors. These changes can be seen in the short version of the guideline (https://www.nice.org.uk/guidance/NG28).

Commissioned by the National Institute for Health and Care Excellence

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.