Type 2 diabetes in adults: management

Context

Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance (that is, the body's inability to effectively use insulin) and insufficient pancreatic insulin production, resulting in high blood glucose levels (hyperglycaemia). Type 2 diabetes is commonly associated with obesity, physical inactivity, raised blood pressure, periodontitis, disturbed blood lipid levels and a tendency to develop thrombosis, and is therefore recognised to have an increased cardiovascular risk. It is associated with long‑term microvascular and macrovascular complications, together with reduced quality of life and life expectancy.

In 2019, approximately 3.2 million adults in the UK had diagnosed diabetes. About 90% of these people had type 2 diabetes. Type 2 diabetes is more common in people of African, African‑Caribbean and South Asian family background. It can occur in all age groups and is increasingly being diagnosed in adolescents and young adults.

Multiple vascular risk factors and wide‑ranging complications make diabetes care complex and time-consuming, and many areas of healthcare services must be involved for optimal management. Necessary lifestyle changes, and the complexities and possible side effects of therapy, make structured education and self‑management important aspects of diabetes care. Diabetes care is estimated to account for at least 5% of UK healthcare expenditure, and up to 10% of NHS expenditure.

This guideline contains recommendations for managing type 2 diabetes in adults, and focuses on education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long‑term complications. The guideline does not cover diagnosis, secondary diabetes, type 1 diabetes in adults, diabetes in pregnancy or diabetes in children and young people.