NICE Type 2 Diabetes Management Guidelines Urgently Need Updating

NICE Type 2 Diabetes Management Guidelines Urgently Need Updating

Dr Sean Wheatley, MSc, PhD. Science and Research Lead.

It is estimated that nearly six million people in the UK live with diabetes, with 90% of these having type 2 diabetes. Type 2 diabetes is manageable, and can often even be put into remission. Without appropriate care though, it can have serious consequences.

In many cases, type 2 diabetes is a dietary condition. Despite this, the dietary advice in the type 2 diabetes management guidelines provided by the National Institute for Health and Care Excellence (NICE) has not been updated in over 15 years. It is time for this to change.

What are we doing about it?

Working with colleagues at the British Dietetic Association (BDA)* and the Public Health Collaboration (PHC), we have written an open letter to NICE setting out why we believe their type 2 diabetes management guidelines urgently need updating. You can read this letter here, but the purpose of this blog is to summarise some of the key points.

NICE have confirmed receipt of this letter and have stated that its content will be discussed with the relevant teams. This is a good start, but we want to continue raising awareness of this issue.

Why do the guidelines need updating?

Since the guidelines were last updated there have been significant advances in the dietary care of people with type 2 diabetes. These are reflected in other national and international guidelines, creating an inconsistency between them and the recommendations provided by NICE**. This can cause confusion for healthcare professionals and people with type 2 diabetes.

The bottom line is that the NICE guidelines are now out of date, and this presents a potential barrier to effective patient care.

Key elements of other guidelines which we believe should be included in the NICE guidelines include:

– Remission of type 2 diabetes is a realistic goal.

– There is a range of dietary approaches that are safe and effective, and so should be included in the options discussed with patients. This includes low carbohydrate diets, Mediterranean-style diets, and energy restricted diets (including diets using meal-replacement products).

– There should be a focus on helping patients to make informed choices that fit their own needs and preferences, to help them adopt an approach that will work for them long-term.

Organisations that provide guidelines that align with the points above include Diabetes UK, the BDA, the Scottish Intercollegiate Guidelines Network, the American Diabetes Association, the European Association for the Study of Diabetes, and Diabetes Australia.

However, where there is any confusion or discrepancy between guidelines many healthcare professionals in the UK will defer to the recommendations provided by NICE.

What difference would updating the guidelines make?

Making changes in line with the points above would address a range of issues and inconsistencies, and so would remove a barrier to effective care.

It would help healthcare professionals to feel more comfortable and confident with supporting their patients to explore different lifestyle options. It would therefore support shared decision making between patients and their healthcare teams, helping to ensure people with diabetes can make informed and individualised choices that are right for them.

Most importantly, this will help people with diabetes 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.

So, what’s the bottom line?

The days of type 2 diabetes being considered a progressive condition are over. The evidence is clear that this progression can be halted, and that many people can even achieve remission.

The days where a one-size-fits-all approach is taken to the management of type 2 diabetes are over too. The evidence is clear that multiple dietary approaches are safe and can be effective.

It is high time that the NICE type 2 diabetes management guidelines were updated to reflect these points. This will remove inconsistencies with other national and international guidelines; it will remove confusion amongst healthcare professionals and people with diabetes; and it will remove barriers to effective patient care.

Lastly, to repeat myself, it will (most importantly) 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. At the end of the day, this is what healthcare is supposed to be about.

* The BDA post about this campaign can be found here: https://www.bda.uk.com/resource/the-bda-calls-for-an-urgent-update-of-nice-guidance-type-2-diabetes-in-adults.html

** There are even inconsistencies between some of NICE’s own guidelines. This includes that their weight management guidelines, which were updated this year, support the use of a range of dietary approaches (including low carbohydrate diets), even though their type 2 diabetes guidelines do not. Other inconsistencies in NICE’s recommendations are noted in the full letter.