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New guidelines for Type 2 issued by the National Institute of Health and Care Excellence

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New clinical guidance published today (December 2) by the National Institute for Health and Care Excellence (NICE) may be “putting unnecessary obstacles in the way of people with Type 2 diabetes getting best care”, according to Diabetes UK.Theguidance, designed to help healthcare professionals support people with Type 2 diabetes and provide commissioners with a framework to commission appropriate services, has finally been published after long delays. This was because contributors, including Diabetes UK, argued that further changes needed to be made to make the final guidelines more practical in line with other international guidelines.

Timely action needed from NICE

While the charity is broadly supportive of the new guidelines, it is still concerned that, even with solid evidence, NICE is still continuing to wait far too long before making changes to the guidelines that could benefit patients.

The charity says the consequences may not be a problem for specialist clinicians, because they tend to be up-to-date and change their practices accordingly. Diabetes UK says the key issue is that the vast majority of people with Type 2 diabetes will be seen by generalist clinicians who often rely heavily on the guidelines, may not be up to speed with the application of new evidence and may be reluctant to go beyond out-of-date existing guidelines. The concern is that this could lead to many patients waiting unnecessarily to get access to tried and tested newer therapies.

Charity calling for regular review process

Diabetes UK is calling on NICE to put in place a regular review process that looks at emerging evidence and fully incorporates these into existing guidelines on an ongoing basis so patients are not left waiting five years or more for an update. Although NICE has advised in the guidelines that it is ‘considering’ setting up a standing update committee to enable more rapid updating of certain areas of diabetes guidelines, nothing has yet been confirmed.Where the charity says the guidelines have made strides is in the clear emphasis on encouraging healthcare professionals to individualise care and to prioritise care planning. Diabetes UK is now calling on clinicians to use information from the guidelines but also to apply their clinical judgement in discussing all appropriate options for medication regimes, and to work jointly with the person with diabetes when making decisions thereby treating them as an individual to better meet their specific needs.

Better access to education

Another key recommendation in the guidance is for people with Type 2 diabetes to be offered better access to education. Diabetes UK welcomes this recommendation and has recently launched its ‘Taking Control’ campaign, which calls for more people to get access to the education they need to better self-manage their condition. To increase education uptake, it is essential that CCGs have a plan in place to deliver more education services and increase uptake by working in partnership with clinicians. It is also important that healthcare professionals find out what quality diabetes education courses are available in their area and discuss the benefits of an education course with people with diabetes.

Chris Askew, Chief Executive of Diabetes UK, said: “There are many things we welcome from these new guidelines but we are calling on NICE to commit to on-going updates so that people with Type 2 diabetes can benefit from latest advances in medication and diabetes care. Diabetes treatment is an ever-changing field so it is important for recommendations to be updated regularly to reflect new evidence. We urge NICE to go ahead and set up the proposed standing committee to enable a far more rapid update of reputable diabetes guidance. Up-to-date guidelines will enable generalist practitioners to support people with diabetes to manage their condition far better, so they can reduce their risk of developing devastating complications. We also encourage CCGs and healthcare professionals to increase access to diabetes education and appropriate blood glucose monitoring to help with self-management.”

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