NICE Type 2 Diabetes Management Guidelines – An Update on Our Call for Them to Be Updated!
Dr Sean Wheatley, MSc, PhD. Science and Research Lead.
In a recent blog we outlined an open letter we sent to the National Institute for Health and Care Excellence (NICE) to encourage them to update their dietary advice for people with type 2 diabetes. This month’s blog provides an update on our efforts – spoiler alert, it is (provisionally) good news!
What we asked for
Our letter, which was sent in collaboration with the British Dietetic Association (BDA) and the Public Health Collaboration (PHC), set out a range of reasons why we felt the current guidelines should be urgently reviewed.
Key factors we felt needed updating included that:
– Remission of type 2 diabetes should be promoted as a realistic goal.
– A range of dietary approaches should be supported, including low carbohydrate dietary approaches.
– There should be a focus on helping patients to make informed choices that fit their own needs and preferences.
Why we asked for it
The existing guidelines are outdated, they are inconsistent with other major national and international guidelines, and they fail to support patient choice. Ultimately, we were concerned that these issues present a barrier to effective patient care.
What NICE have said
In response to our letter, NICE have confirmed that they will be making amendments to their type 2 diabetes management guidelines to address our concerns. Although we will have to wait and see exactly what the updated recommendations look like, this is fantastic news!
These changes will be made at the same time as a medicines update that is already planned. The publication of this is expected on 30th July 2025 [Update, 08/07/25: the publication date has unfortunately been delayed, with our best estimate, based on the available information, being that the draft guidance will now be published in September at the earliest. We are still hopeful that the final version of the update will be published this year, but only time will tell].
What can we expect from the updated guidelines?
As alluded to above, we will have to wait and see exactly how the reviewed advice looks. Elements of NICE’s response point to what can be expected though, including that:
– Existing recommendations will be amended to include “lowering specific macronutrient content” as a suitable approach for achieving weight loss, in line with recommendation 1.16.3 in the NICE Overweight and Obesity Management Guidelines (NG246). This recommendation lists low fat and low carbohydrate approaches as examples of “lowering specific macronutrient content”. As such, the updated NICE dietary advice for people with type 2 diabetes can be expected to explicitly support a range of dietary approaches.
– A cross-reference will be added to recommendations in NG246 related to low- and very-low-energy diets (like those used in DiRECT – more on which can be found here). Reference to the NHS Pathways to Remission programme will also be included. These amendments should help to emphasise that remission of type 2 diabetes is a realistic treatment goal.
– The dietary advice section will be “editorially refreshed” in line with the wording used in NG246. This should further help to ensure the updated guidelines will support shared decision making, emphasise patient choice, and promote individualised and flexible approaches more effectively than the current guidelines do.
Overall, NICE’s response suggests that the updated dietary advice in their type 2 diabetes guidelines (NG28) is likely to be very similar to the dietary advice in their weight management guidelines (NG246). This would, in my opinion at least, be a significant improvement on the existing type 2 diabetes guidelines.
So, what’s the bottom line?
NICE have listened to our concerns and have committed to take steps to address them. This is (provisionally at least) great news!
Although we will have to wait for the specifics, from NICE’s response we can expect the new guidelines to support a range of dietary approaches for the management of type 2 diabetes and to promote remission of type 2 diabetes as a realistic treatment goal. These changes should remove inconsistencies with other key guidelines, reduce confusion amongst healthcare professionals and people with diabetes, and reduce barriers to effective patient care. Most importantly, they should help to support patients to adopt a lifestyle that is right for them, that helps them to achieve their health goals, and that gives them hope for the future.
A quick thank you…
Thank you to everyone who contributed to or supported this campaign, including the co-authors, the reviewers, and the healthcare professionals and organisations who signed and endorsed the letter.
