Guidance

Update information

Update information

June 2022: We reviewed evidence on periodontitis in people with type 2 diabetes, and made new recommendations. These recommendations are marked [2022].

March 2022: We reviewed the evidence on continuous glucose monitoring for adults with type 2 diabetes. These recommendations are marked [2022].

We also made one change without an evidence review: in the section on self-monitoring of capillary blood glucose, the word 'capillary' has been added to the heading and recommendations, to make it clear that recommendations apply to adults who are using capillary blood glucose monitoring rather than CGM. These recommendations are marked [2015, amended 2022].

Recommendations are marked to show when they last had an evidence review, for example [2009] or [2015]. In some cases, minor changes have been made to the wording to bring the language and style up to date, without changing the meaning.

We also added a cross-reference to NICE's technology appraisal guidance on dapagliflozin for treating chronic kidney disease in the section on managing complications.

February 2022: We reviewed the evidence and made new recommendations on drug treatment for adults with type 2 diabetes. These recommendations are marked [2022].

We also made some changes without an evidence review:

  • We have replaced 'individually agreed threshold for intensification' throughout with 'individually agreed threshold for further intervention' for clarity. (Intensification was also removed from recommendation for research 3.)

  • In recommendation 1.1.1 we have removed 'because of reduced life expectancy'.

  • Figure 1: Your target HbA1c: weighing it up has been added to the guideline as a tool that people can choose to use to help them discuss their HbA1c target with their healthcare professional.

  • In recommendation 1.7.1 contraindications and weight have been added as examples to the bullet point about individual clinical circumstances. Monitoring requirements has been added as a separate bullet, and cardiovascular and renal protection have been added to bullet point 3 on effectiveness of the drug treatments.

  • Recommendation 1.7.10 was amended to make it clear that it applies to people who are not in either of the high cardiovascular risk groups in recommendation 1.7.9. The NICE technology appraisals have been added as a bullet point to show that they may be treatment options at this stage. Information on repaglinide has been removed from the guideline.

  • 'Initial drug treatment with metformin' was changed to 'monotherapy' in recommendation 1.7.18 because people may now be taking an SGLT2 inhibitor as monotherapy at this stage. The bullets have been simplified to show which drug could be added (rather than stating combinations) and the NICE technology appraisals have been added as a bullet point.

  • The bullets in recommendation 1.7.19 have been simplified to show which drug could be added (rather than stating combinations) and the NICE technology appraisals have been added as a bullet point.

  • In recommendation 1.7.21 'consider combination therapy with metformin, a sulfonylurea and a glucagon‑like peptide‑1 (GLP‑1) mimetic' was changed to 'consider triple therapy by switching one drug for a GLP‑1 mimetic' to reflect that people might be taking an SGLT2 inhibitor.

These recommendations are marked [2015, amended 2022].

November 2021: We reviewed the evidence and made new recommendations on SGLT2 inhibitors for adults with type 2 diabetes and chronic kidney disease. They are marked [2021].

December 2020: We amended recommendations 1.8.25 and 1.8.28 to bring them in line with the diabetic eye screening programme. The evidence for these recommendations has not been reviewed, and they are marked [2009, amended 2020].

August 2019: The recommendations in section 1.4 on diagnosing and managing hypertension have been removed because diagnosis, treatment and monitoring of hypertension is broadly the same for people with type 2 diabetes as for other people (see the NICE guideline on hypertension in adults). When a different approach is needed for people with type 2 diabetes, this is specified in the hypertension guideline.

December 2015: We updated and replaced NICE guideline CG87 (published May 2009) and NICE technology appraisal guidance 203 and 248. We made a change without an evidence review. The recommendation on the treatment of gastroparesis was replaced by recommendations from the NICE guideline on type 1 diabetes. This change is labelled [2015].

Minor changes since publication

August 2024: We added a link to NICE's guideline on diabetic retinopathy in the section on managing complications.

August 2022: We added a new recommendation to the section on reviewing drug treatments, to clarify what to do for adults who start taking an SGLT2 inhibitor before they are 40. This recommendation is marked [2022].

We also updated the visual summary following stakeholder feedback. See the tables on summary of first-line medicines and on summary of medicines for further treatment.

May 2022: We added a link to NICE's guideline on medicines associated with dependence or withdrawal symptoms in the section on autonomic neuropathy.

December 2019: Relationships to the NICE guideline on hypertension were clarified, and a link was added to the decision aid on choice of medicine to control blood glucose. We added a link to the patient decision aid and user guide about taking a second medicine to control blood glucose.

June 2018: Recommendation 1.3.11 was added to provide a link to NICE's advice on bariatric surgery.

ISBN: 978-1-4731-1477-7