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National Collaborating Centre for Chronic Conditions (UK). Type 2 Diabetes: National Clinical Guideline for Management in Primary and Secondary Care (Update). London: Royal College of Physicians (UK); 2008. (NICE Clinical Guidelines, No. 66.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Type 2 Diabetes

Type 2 Diabetes: National Clinical Guideline for Management in Primary and Secondary Care (Update).

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4Glossary and definitions


Angiotensin-converting enzyme inhibitor


Albumin creatinine ratio


American Diabetes Association


Albumin excretion rate – a measure of kidney damage due to diabetes (and other conditions) and a risk factor for arterial disease.


The presence of albumin and other proteins in urine.

Alpha-glucosidase inhibitors

Group of drugs which inhibit the digestion of complex carbohydrates in the gut, and thus flatten the post-meal blood glucose excursion.


Body mass index – a index of body weight corrected for height.

Cohort study

A retrospective or prospective follow-up study. Groups of individuals to be followed up are defined on the basis of presence or absence of exposure to a suspected risk factor or intervention. A cohort study can be comparative, in which case two or more groups are selected on the basis of differences in their exposure to the agent of interest.


Chronic kidney disease

Confidence interval (CI)

A range of values which contains the true value for the population with a stated ‘confidence’ (conventionally 95%). The interval is calculated from sample data, and generally straddles the sample estimate. The 95% confidence value means that if the study, and the method used to calculate the interval, is repeated many times, then 95% of the calculated intervals will actually contain the true value for the whole population.

Cochrane review

The Cochrane Library consists of a regularly updated collection of evidence-based medicine databases including the Cochrane Database of Systematic Reviews (reviews of randomised controlled trials prepared by the Cochrane Collaboration).


Concordance is a concept reflecting the extent to which a course of action agreed between clinicians and a person with diabetes is actually carried out; often but not solely used in the sense of therapeutic interventions or behavioural changes.

Cost-effectiveness analysis

An economic study design in which consequences of different interventions are measured using a single outcome, usually in natural units (for example, life-years gained, deaths avoided, heart attacks avoided, cases detected). Alternative interventions are then compared in terms of cost per unit of effectiveness.

Cost-utility analysis

A form of cost-effectiveness analysis in which the units of effectiveness are quality adjusted life years.


Diabetes Control and Complications Trial – a landmark study of the effects of intensification of diabetes care on development of microvascular complications.

Diabetes centre

A generic term for a source of a unified multidisciplinary diabetes service.

Diabetes mellitus

Chronic condition characterised by elevated blood glucose levels. Diabetes is of diverse aetiology and pathogenesis, and should not be regarded as a single disease. Predominant types are Type 1 diabetes and Type 2 diabetes, diabetes secondary to other pancreatic disease or other endocrine disease, and diabetes of onset in pregnancy.

Diabetes UK

Self-help charity for people with diabetes in the UK, and a professional organisation for diabetes care.


In the context of this guideline, patient education in self-management of everyday diabetes issues like insulin therapy, dietary changes, self-monitoring of glucose level, physical exercise, coping with concurrent illness, how to avoid hypoglycaemia, complications, arterial risk control, jobs, travel, etc.


Fasting blood glucose level or concentration


Fasting plasma glucose level or concentration

Framingham equation

A widely known and used calculation of arterial risk, derived from a long-term study in Framingham, Massachusetts. Not valid in people with Type 1 or Type 2 diabetes.


Guideline Development Group

Glucose excursions

Change in blood glucose levels especially after meals.


Glomerular filtration rate – a measure of kidney function.


Glycated haemoglobin – see HbA1c.




The predominant form of glycated haemoglobin, present in red blood cells, and formed when the normal haemoglobin A reacts non-enzymatically with glucose. As the reaction is slow and only concentration dependent, the amount of HbA1c formed is proportional only to the concentration of HbA and glucose. As HbA remains in the circulation for around 3 months, the amount of HbA1c present, expressed as a percentage of HbA, is proportional to the glucose concentration over that time.


Health Technology Assessment, funded by the NHS Research and Development Directorate.


International Diabetes Federation – a global federation of diabetes associations.

Incremental cost

The cost of one alternative less the cost of another.

Incremental cost effectiveness ratio (ICER)

The ratio of the difference in costs between two alternatives to the difference in effectiveness between the same two alternatives.

Insulin analogues

A derivative of human insulin in which change of the amino-acid sequence alters duration of action after injection.

Insulin regimen

A therapeutic combination of different insulin preparations, including time of injection and frequency during a day.


Ischaemic heart disease


A statistical technique for combining (pooling) the results of a number of studies that address the same question and report on the same outcomes to produce a summary result.

Metabolic syndrome

Overweight (abdominal adiposity), insulin insensitivity, higher blood pressure, abnormal blood fat profile.

Methodological limitations

Features of the design or reporting of a clinical study which are known to be associated with risk of bias or lack of validity. Where a study is reported in this guideline as having significant methodological limitations, a recommendation has not been directly derived from it.


Myocardial infarction


A low but clinically significant level of albumin and other proteins in the urine.


The National Collaborating Centre for Chronic Conditions, set up in 2000 to undertake commissions from the NICE to develop clinical guidelines for the NHS.


National Health Service – this guideline is written for the NHS in England and Wales.


National Institute for Health and Clinical Excellence – a special health authority set up within the NHS to develop appropriate and consistent advice on healthcare technologies, and to commission evidence-based guidelines.

NPH insulin

Neutral protamine Hagedorn insulin – a basal insulin, named after the Danish researcher Hans Christian Hagedorn, and developed in the 1940s. Synonymous with isophane insulin.


Not significant (at the 5% level unless stated otherwise).


National Screening Committee (UK)


National Service Framework – a nationwide initiative designed to improve delivery of care for a related group of conditions.

Observational study

Retrospective or prospective study in which the investigator observes the natural course of events with or without control groups, for example cohort studies and case-control studies.

Odds ratio

A measure of relative treatment effectiveness. An odds ratio of 1 means equality between the comparisons in the study, and higher numbers mean greater differences. The odds of an event happening in the intervention group, divided by the odds of it happening in the control group.

PDE5 inhibitors

Phosphodiesterase type 5 inhibitors, a class of drugs developed in recent years to treat erectile dysfunction.


Prospective Cardiovascular Münster Heart Study – an epidemiological study performed in Germany.


The presence of protein in the urine.


The probability that an observed difference could have occurred by chance. A p-value of less than 0.05 is conventionally considered to be ‘statistically significant’.

Quality of life

A term used to describe an individual’s level of satisfaction with their life and general sense of well-being. It is often measured as physical, psychological and social well-being.

Quality of life-adjusted year (QALY)

A measure of health outcome which assigns to each period of time a weight, ranging from 0 to 1, corresponding to the health-related quality of life during that period, where a weight of 1 corresponds to optimal health, and a weight of 0 corresponds to a health state judged equivalent to death; these are then aggregated across time periods.


Randomised controlled trial. A trial in which people are randomly assigned to two (or more) groups – one (the experimental group) receiving the treatment that is being tested, and the other (the comparison or control group) receiving an alternative treatment, a placebo (dummy treatment) or no treatment. The two groups are followed up to compare differences in outcomes to see how effective the experimental treatment was. Such trial designs help minimise experimental bias.


Relative risk

Sensitivity analysis

A measure of the extent to which small changes in parameters and variables affect a result calculated from them. In this guideline, sensitivity analysis is used in health economic modelling.

Short-form 36 (SF-36)

The SF-36 assesses functioning and well-being in chronic disease. Thirty-six items in eight domains are included, which cover functional status, well-being, and overall evaluation of health.


A clinician whose practice is limited to a particular branch of medicine or surgery, especially one who is certified by a higher medical educational organisation.


Any national organisation, including patient and carers’ groups, healthcare professionals and commercial companies with an interest in the guideline under development.

Statistical significance

A result is deemed statistically significant if the probability of the result occurring by chance is less than 1 in 20 (p<0.05).

Systematic review

Research that summarises the evidence on a clearly formulated question according to a pre-defined protocol using systematic and explicit methods to identify, select and appraise relevant studies, and to extract, collate and report their findings. It may or may not use statistical meta-analysis.

Technology appraisal

Formal ascertainment and review of the evidence surrounding a health technology, restricted in the current document to appraisals undertaken by NICE.


A group of drugs which improve insulin sensitivity in people with reduced sensitivity to their own or injected insulin; presently the licensed drugs are both of the chemical group known as trivially ‘glitazones’ or PPAR-γ agonists.

Type 1 diabetes

Insulin-deficiency disease, developing predominantly in childhood, characterised by hyperglycaemia if untreated, and with a consequent high risk of vascular damage usually developing over a period of decades.

Type 2 diabetes

Diabetes generally of slow onset mainly found in adults and in association with features of the metabolic syndrome. Carries a very high risk of vascular disease. While not insulin dependent many people with the condition eventually require insulin therapy for optimal blood glucose control.


Urinary albumin excretion rate


United Kingdom Prospective Diabetes Study – a landmark study of the effect of different diabetes therapies on vascular complications in people with Type 2 diabetes.


World Health Organization

Copyright © 2008, Royal College of Physicians of London.

All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher.

Bookshelf ID: NBK53903


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