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NICE backs tougher diabetes control in guidance update proposals

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Nurses will be expected to provide more intensive treatment and support to help children and adults with diabetes manage their condition, under new guidance proposed by the National Institute for Health and Care Excellence.

The two draft guideline documents, which highlight the key role of specialist nurses, cover adults with type 1 diabetes and children and young people with either type 1 or type 2.

They update NICE recommendations published in 2004, and reflect major advances in diabetes care covering areas including diagnosis, insulin therapy, dietary advice, hospital care and education courses for children and adults.

“It is now possible for many to achieve much stricter targets for their blood sugar levels”

Mark Baker

The guidance emphasises the important role of specialist diabetes nurses within multi-disciplinary teams and flags up evidence of the potential health gains and cost benefits of employing them.

However, the update also acknowledges that efforts to develop the best diabetes care, including the wider use of specialist nurses, “had been inhibited by funding difficulties”.

The drafts feature many new recommendations including the first national guidance on how to help children achieve near normal blood glucose levels.

“In the past decade there have been major changes in how we routinely manage both adults and children with diabetes, and it is now possible for many to achieve much stricter targets for their blood sugar levels,” said Professor Mark Baker, director of clinical practice at NICE.

“Both draft guidelines cover new technologies which support better diabetes control with evidence-based advice how to use these to support adults and children in living their lives to the fullest,” he said.

Mark Baker

Mark Baker

Diabetes teams will be expected to help children get on top of their condition with a combination of intensive insulin management in the form of daily injection or the use of portable insulin pumps and specific advice and education on diet.

The guidelines also include new recommendations on working with the much smaller number of children with type 2 diabetes, including diagnosing and treating complications such as kidney problems, high blood pressure and high cholesterol.

The guidelines for adults with type 1 also place much more emphasis on the need to ensure patients hit blood sugar targets

The document calls for more frequent monitoring and recommends adults with type 1 be seen at least every three to six months to have their blood sugar measured.

Those who self-monitor should also do this more regularly – at least four times a day or even more frequently if they are not achieving targets or doing activities like driving and sport.

All should attend a structured education course to boost their understanding of the condition while multiple daily insulin injections should be offered as the treatment of choice.

The guidelines continue to recommend the use of “nurses with training in teaching skills and adult education” to deliver patient education programmes.

The consultation on the two documents is open until 4 March next year. NICE is also updating its guidelines for type 2 diabetes in adults and diabetic footcare, which will be open for consultation from January.

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