Excerpt

Type 1 diabetes affects over 370,000 adults in the UK, representing approximately 10% of adults diagnosed with diabetes. Given the complexity of its treatment regimens, successful outcomes depend, perhaps more than with any other long-term condition, on full engagement of the adult with type 1 diabetes in life-long day-by-day self-management. In order to support this, the health service needs to provide informed, expert support, education and training as well as a range of other more conventional biomedical services and interventionsfor the prevention and management of long term complications and disability.

The number of adults with type 1 diabetes means that, while the condition is certainly not rare, it is not common enough to provide and maintain all the necessary skills in its management for all healthcare professionals who will deal with it. The aim of this guideline is, therefore, to provide evidence-based, practical advice on the steps necessary to support adults with type 1 diabetes to live full, largely unrestricted, lives and avoid the acute and long-term complications of both the disease and of its treatment. NICE last produced such a guideline in 2004. The present guideline is an update of many sections of that guideline, focusing on areas where new knowledge and new treatment opportunities have arisen in the last decade. There have been many such developments, resulting in improving outcomes for adults with type 1 diabetes, but also presenting more challenges in the diversity and complexity of the tools they now have to achieve these outcomes.

Contents

• Guideline development group members
• NCGC technical team members
• Expert adviser
• Acknowledgements
• 1. Introduction
  • Aim of this guideline
  • Background
  • Current practice: ideal and achieved
  • Target audience
  • 1.1. Living with type 1 diabetes
• 2. Development of the guideline
  • 2.1. What is a NICE clinical guideline?
  • 2.2. Remit
  • 2.3. Epidemiology
  • 2.4. Who developed this guideline?
  • 2.5. What this guideline covers
  • 2.6. What this guideline does not cover
  • 2.7. Relationships between the guideline and other NICE guidance
• 3. Methods
  • Amendments to 2004 text
  • 3.1. Developing the review questions and outcomes
  • 3.2. Searching for evidence
  • 3.3. Evidence of effectiveness
  • 3.4. Evidence of cost effectiveness
  • 3.5. Developing recommendations
  • 3.6. Methods 2004
• 4. Guideline summary
  • 4.1. Algorithms
  • 4.2. Key priorities for implementation
  • 4.3. Full list of recommendations
  • 4.4. Full list of research recommendations
  • 4.5. Key research recommendations
• 5. Diagnosis
  • 5.1. Introduction
  • 5.2. Review question: In adults with diabetes, what is the best marker (C-peptide plus or minus antibodies) to distinguish between a diagnosis of type 1 diabetes, type 2 diabetes and other forms of diabetes?
  • 5.3. Clinical evidence
  • 5.4. Economic evidence
  • 5.5. Evidence statements
  • 5.6. Recommendations and link to evidence
  • 5.7. Research recommendation
• 6. Care process and support [2004]
  • 6.1. Scope of this chapter [2004]
  • 6.2. Optimal healthcare processes [2004]
  • 6.3. Support groups [2004]
  • 6.4. Quality audit and monitoring [2004]
• 7. Education programmes and self-care
  • 7.1. Rationale [2004]
  • 7.2. Structured education programmes [updated 2015]
  • 7.3. Dietary management
  • 7.4. Physical activity [2004]
  • 7.5. Cultural and individual lifestyle[2004]
• 8. Blood glucose control
  • 8.1. Optimum target HbA1c level and frequency of HbA1c monitoring
  • 8.2. Self-monitoring of blood glucose
  • 8.3. Technologies for self-monitoring of blood glucose
  • 8.4. Continuous glucose monitoring (CGM) compared with self-monitoring of blood glucose
• 9. Insulin therapy
  • 9.1. Introduction
  • 9.2. Insulin regimens
  • 9.3. Insulin delivery
• 10. Referral for islet or pancreas transplantation
  • 10.1. Introduction
  • 10.2. Review question: Which adults with type 1 diabetes are most suitable to be considered for a pancreas transplant, or pancreatic islet cell transplantation?
  • 10.3. Clinical evidence
  • 10.4. Economic evidence
  • 10.5. Evidence statements
  • 10.6. Recommendations and link to evidence
• 11. Impaired awareness of hypoglycaemia [2015]
  • 11.1. Identification and quantification of impaired awareness of hypoglycaemia
  • 11.2. Strategies for the management of impaired awareness of hypoglycaemia
  • 11.3. Prevention, problems related to hypoglycaemia, and management of symptomatic hypoglycaemia [2004]
• 12. Ketone monitoring and management of diabetic ketoacidosis (DKA)
  • 12.1. Ketone monitoring [2015]
  • 12.2. Clinical evidence
  • 12.3. Economic evidence
  • 12.4. Management of DKA [2004]
  • 12.5. Recommendations [2004]
• 13. Associated illness [2004]
  • 13.1. Introduction
  • 13.2. Rationale [2004]
  • 13.3. Evidence statements [2004]
  • 13.4. Health economic evidence [2004]
  • 13.5. Considerations [2004]
  • 13.6. Recommendations
• 14. Arterial risk control
  • 14.1. Aspirin for the primary prevention of cardiovascular disease [2015]
  • 14.1.4. Recommendations and link to evidence
  • 14.1.5. Research recommendations
  • 14.2. Identification of arterial risk [2004]
  • 14.3. Interventions to reduce risk and to manage arterial disease [2004]
  • 14.4. Blood pressure [2004]
• 15. Inpatient management
  • 15.1. Introduction [2015]
  • 15.2. Inpatient management [2004]
• 16. Management of complications
  • 16.1. Eye disease [2004]
  • 16.2. Diabetic kidney disease: kidney damage [2004]
  • 16.3. Chronic painful diabetic neuropathy [2004]
  • 16.4. Autonomic neuropathy [2004]
  • 16.5. Gastroparesis [2015]
  • 16.6. Acute painful neuropathy of rapid glycaemic control [2015]
  • 16.7. Diabetes foot problems [2004]
  • 16.8. Erectile dysfunction [2015]
  • 16.9. Thyroid disease -frequency of monitoring [2015]
  • 16.10. Psychological problems [2004]
  • 16.11. Eating disorders [2004]
  • 16.12. Management of special situations [2004]
• 17. Reference list
• 18. Acronyms and abbreviations
• 19. Glossary
• Appendices A – F
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Review protocols
  • Appendix D. Clinical article selection
  • Appendix E. Economic article selection
  • Appendix F. Literature search strategies
  • References
• Appendix G. Clinical evidence tables
• Appendices H-U
  • Appendix H. Economic evidence tables
  • Appendix I. GRADE tables
  • Appendix J. Forest plots
  • Appendix K. Excluded clinical studies
  • Appendix L. Excluded economic studies
  • Appendix M. Network meta-analysis: long-acting insulin
  • Appendix N. Cost-effectiveness analysis: Long-acting insulin and insulin regimen
  • Appendix O. Cost-effectiveness analysis - HbA1c threshold
  • Appendix P. Cost-effectiveness analysis – Continuous glucose monitoring (CGM) versus standard monitoring of blood glucose (SMBG)
  • Appendix Q. Unit costs
  • Appendix R. Research recommendations
  • Appendix S. Removed text from CG15
  • Appendix T. Changes to recommendations from 2004 guideline
  • Appendix U. NICE technical team
  • References

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.