Endocrine Abstracts

Published in August 2015, this was an update of the 2004 guidelines including for the first time guidance concerning Type 2 in Children. Monogenic diabetes fell outside the scope of the group and the update should be read alongside recent publications on Adult type 1 diabetes, diabetes in pregnancy, the diabetic foot, coeliac disease and the Technology Appraisal of insulin pumps. The Adult type 2 guidance will be published shortly.

Guidelines must meet standards of trustworthiness to be authoritative and the mechanisms for quality assurance and economic analysis of NICE guidance will be discussed.

Highlights of the update include lower targets for a team message – HbA <6.5%; carbohydrate counting and intensive insulin from day 1; recommendations on a minimum of five tests per day; the use of CGMS for selected groups and a new treatment protocol for DKA.

The 2004 guidelines specified that there should be provision of psychological and educational support for all, but this has still not been universally implemented 11 years later and it is likely some of the new guidance may also be difficult to implement within current constraints.

Finally the group chose key areas for future research around DKA, Type 2 diabetes management, optimal psychological care, education programmes, glycaemic index and the use of CGMS with pumps in the young.

Future NICE updates may be piecemeal as new information becomes available rather than comprehensive reviews.