An update to the NICE type 2 diabetes guideline takes into account recommendations from its guidance on chronic kidney disease on the joint management of both conditions

Diabetes drugs and equipment

NICE has updated its guideline for the management of type 2 diabetes in adults. NICE Guideline (NG) 28 contains new recommendations on the management of chronic kidney disease and type 2 diabetes, including advice on when to offer angiotensin receptor blockers or angiotensin converting enzyme inhibitors, as well the criteria under which the addition of a sodium–glucose co-transporter-2 inhibitor (SGLT-2i) should be considered.

NICE has said that the recommendations will lead to ‘a significant change in practice, since SGLT2 inhibitors will be prescribed more widely. This will result in a substantial cost impact.’ In addition, the Guideline Development Committee predicted a likely ‘long-term cost saving from reduced downstream treatment costs, as SGLT2 inhibitors slow chronic kidney disease progression and reduce the number of cardiovascular and end-stage renal events’.

NG28 estimates that diabetes care accounts for at least 5% of UK healthcare expenditure, and up to 10% of NHS expenditure. Achieving optimal diabetes management requires the input of many different healthcare services because of the multiple vascular risk factors and wide-ranging associated complications of the condition. NICE has indicated that patient education and self-management are important aspects of diabetes care because of the lifestyle changes required and the complexities and possible side effects of therapy.

The update offers recommendations on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications. NG28 does not cover diagnosis, secondary diabetes, type 1 diabetes in adults, diabetes in pregnancy, and diabetes in children and young people.

The guideline committee recommended further research into the effectiveness of SGLT-2is, both in different ethnic groups and in those with a urine albumin:creatinine ratio of less than 3 mg/mmol.

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