Guidance

Update information

Update information

December 2020: We have reviewed the evidence and made new recommendations on continuous glucose monitoring (CGM) and intermittently scanned CGM (flash) during pregnancy for women with type 1 diabetes. These recommendations are marked [2020].

We have also made some changes without an evidence review:

  • we have made minor amendments to recommendation 1.1.3 for clarity

  • we have updated recommendation 1.1.12 to clarify timing of measurement

  • we have added out-of-hours support to recommendation 1.3.20

  • we have made minor amendments to recommendation 1.3.25 to clarify the actions

  • we have updated recommendations on retinal assessment before pregnancy in line with the diabetic eye screening programme

  • we have removed glibenclamide from the guideline (including from recommendations 1.3.6 and 1.6.4) because it has been discontinued

  • we have added referral to the NHS Diabetes Prevention Programme to recommendation 1.6.11.

These recommendations are marked [2008, amended 2020] or [2015, amended 2020].

In some other recommendations, minor changes have been made to the wording to bring the language and style up to date, without changing the meaning.

We added textat the beginning of the section on insulin treatment and hypoglycaemia to highlight a Medicines and Healthcare products Regulatory Agency safety update reminding patients to rotate insulin injection sites within the same body region to avoid cutaneous amyloidosis.

February 2015: We made the following changes without an evidence review:

  • Recommendation 1.1.23 was updated to better reflect the summaries of product characteristics for insulin detemir and insulin glargine, and the possibility of disrupted glucose control for women who switch to isophane insulin during pregnancy.

  • Recommendation 1.1.33 was updated to use the same thresholds and terminology as the NICE guideline on chronic kidney disease

  • Recommendation 1.2.2 was updated to remove mention of specific family origins, because the original list was not exhaustive and potentially missed out some groups.

  • Recommendation 1.3.14 was updated to match current clinical practice

  • Recommendations 1.3.28 to 1.3.31 were updated to clarify renal assessment during pregnancy.

  • Recommendation 1.3.33 and table 1 were updated to address inconsistencies in the guideline on when the fetal heart examination should take place.

  • Recommendation 1.3.35 was updated to clarify which types of monitoring are being referred to.

  • Recommendations 1.6.10 and 1.6.15 were updated to remove mention of women with 'ongoing impaired glucose regulation', because this group need support from their diabetes team rather than just self-monitoring.

These recommendations are marked [2008, amended 2015].

Minor changes since publication

March 2022: We have removed 2 recommendations for research on continuous glucose monitoring, because new research has been carried out in this area. We have also removed the off-label notes from recommendations 1.1.21, 1.2.19, and 1.2.21 to 1.2.23, in line with its summary of product characteristics, and changed the terminology for continuous glucose monitoring to align this guideline with the NICE guidelines on type 1 diabetes in adults, diabetes (type 1 and type 2) in children and young people and type 2 diabetes in adults.

ISBN: 978-1-4731-0993-3