Today, 26 August 2015, new guidance has been published by The National Institute for Health and Care Excellence (NICE) with three sets of recommendations aroundchildren and young people with diabetes (PDF, 334KB),foot care and diabetes (PDF, 216KB), and foradults with Type 1 diabetes (PDF, 307KB). The guidance is designed to help people with diabetes understand the care they should be receiving and crucially provides commissioners with a framework to commission appropriate services.
Need for appropriate support
We welcome the new guidance and commend it for clearly setting out what needs to be in place to achieve good care. However, we know that turning these guidelines into reality depends on commissioners and service providers responding to the recommendations and ensuring that they provide the care and support that people with diabetes need to best manage their condition. For example, children and young people with diabetes are being set tighter blood glucose targets and the evidence shows that this helps reduce the risk of serious complications in the long-term.
However, the government needs to ensure that appropriate support is available to help children and their families to achieve this. We know that the majority of children with Type 1 diabetes already struggle to achieve current blood glucose targets with the most recent figures revealing that less than one in five manage this.
While thetechnology, such as pumps and increased access to continuous blood glucose monitors, is available to support children with Type 1 diabetes reach blood glucose targets, it is critical that they receive the emotional support, such as improved access to specialist psychological care, they and their families need to feel empowered to achieve these new targets.
This is a critical step to ensure that all children with Type 1 diabetes and their families get the care and support they need and gives these children the best possible chance of a long and healthy life.
Strengthening of recommendations for foot care
We are pleased to see a strengthening of recommendations in relation to foot care, to check and protect people’s feet when they are in hospital. We also welcome the recommendation that there should be a Multidisciplinary footcare team (MDfT) in every hospital and that people should be referred immediately to the MDfT if they have a limb-threatening or life-threatening foot problem with referrals within one working day for all acute foot problems.
Again, the issue at stake is making sure we see this happen on the ground as more than a quarter of hospitals still have no MDfT.
The new guidance also clearly states that commissioners and service providers should ensure that a foot protection service is in place for preventing foot problems and for treating and managing diabetic foot problems in the community.
At present, we know that provision of foot protection services is patchy and they can have very long waiting lists. People with diabetes also tell us they have problems getting to see a podiatrist and sometimes struggle to get referred by their GP.
Foot checks are 'a critical part of the jigsaw'
Another recommendation of the guidance is simply that foot checks need to be done. It will be important for us to monitor whether this guidance leads to more checks taking place.
The latest data shows that in 2013 only 43 per cent of people in hospital with diabetes had their feet checked during their hospital stay, and 28 per cent of people with Type 1 diabetes and 13 per cent of people with Type 2 diabetes did not have an annual foot check in 2012-2013. Yet we know that good foot care and regular checks are a critical part of the jigsaw when it comes to preventing amputations.
Structured education for adults with Type 1 given a boost
Tighter blood glucose controls have also been recommended for adults with Type 1 diabetes (there is now a recommendation that adults with Type 1 should aim for a target level of 48mmol/mol (6.5 per cent) or lower, to minimise their risk of developing long-term vascular complications.
But as with the recommendations for children and young people with diabetes, we are keen to understand what support will be put in place to help adults achieve these new targets. Currently only 7.5% of adults with Type 1 diabetes manage to achieve this target.
We are glad that NICE has recommended that all adults with Type 1 diabetes are offered a structured education programme between six and 12 months after diagnosis. There are also many further recommendations in the guidance on education and carb-counting which can benefit people with Type 1 diabetes.
The recommendations made relating to blood glucose testing and continuous blood glucose monitoring (CGM) should also help people to manage their condition better. Yet again the success of these guidelines will lie in their implementation.
Now it’s over to you. We want to hear your verdict on the new NICE guidelines. Are there any recommendations you disagree with? What impact, if any, do you think they will have on your life? We’re keen to hear what you think about them on social media, so do get in touch.