NICE clinical guidelines
Issued: May 2009 (last modified: March 2014)
CG87

Type 2 diabetes: The management of type 2 diabetes

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg87

Introduction

This guideline is a partial update of NICE clinical guideline 66.

Type 2 diabetes is commonly associated with raised blood pressure, a disturbance of blood lipid levels and a tendency to develop thrombosis. It is notable for the increased cardiovascular risk that it carries: coronary artery disease (leading to heart attacks, angina); peripheral artery disease (leg claudication, gangrene); and carotid artery disease (strokes, dementia). The specific ('microvascular') complications of diabetes include eye damage (blindness), kidney damage (sometimes requiring dialysis or transplantation) and nerve damage (resulting in amputation, painful symptoms, erectile dysfunction, other problems). This picture of multiple vascular risk factors and wide-ranging complications means that the management of type 2 diabetes draws on many areas of healthcare management. As a result, diabetes care is typically complex and time-consuming. The necessary lifestyle changes, the complexities of management and the side effects of therapy make self-monitoring and education for people with diabetes central parts of management.

Definition

The guideline recommendations were developed using the World Health Organization (WHO) definition of diabetes, which requires a degree of high plasma glucose levels sufficient to put the individual at risk of the microvascular complications of diabetes. This definition was re-confirmed by WHO in 2006[1] but, like earlier versions, it does not contain a specific definition for type 2 diabetes. A person is normally thought to have type 2 diabetes if he or she does not have type 1 diabetes (rapid onset, often in childhood, insulin-dependent, ketoacidosis if neglected), monogenetic diabetes or other medical conditions or treatment suggestive of secondary diabetes. Diagnosis is not addressed in this guideline.



[1] International Diabetes Federation (2006) Definition and diagnosis of diabetes mellitus and immediate hyperglycemia: report of a WHO/IDF consultation. Geneva: World Health Organization.