NICE Type 2 Diabetes Management Guidelines Update: Big Disappointments and Ongoing Issues
Dr Sean Wheatley, MSc, PhD; Science and Research Lead at X-PERT Health
Sean.Wheatley@xperthealth.org.uk
I have previously written about attempts we (X-PERT Health, with the British Dietetic Association and the Public Health Collaboration) have been making to encourage NICE to update their type 2 diabetes management guidelines (NG28).
The latest stage in what is becoming a bit of a saga has now been reached, with newly published guidelines again failing to address our concerns. This blog provides an overview of what has happened so far, outlines the latest disappointing development, and looks (a little more optimistically) to what we can do next.
Why we’re calling for changes
The reason for our efforts is that we believe there are major issues and limitations with the existing guidelines which risk undermining patient care. These issues are summarised in this blog post.
Key changes we are asking for to address our concerns include that:
– Remission of type 2 diabetes should be promoted as a realistic goal.
– A range of dietary approaches should be supported.
– There should be a focus on helping patients to make informed choices that fit their own needs and preferences.
Ultimately, the dietary advice in the NICE type 2 diabetes management guidelines are outdated and are inconsistent with the recommendations of a range of other influential organisations. They even conflict with other NICE guidelines*!
The story so far
We sent an open letter to NICE in March 2025. This can be viewed here.
We received a response from NICE in April 2025. As set out in this blog post, their response was a positive one. Most importantly, it confirmed their intention to amend the guidelines to address our concerns. The implication was that these changes would be made as part of an update that was already ongoing.
The ongoing update referred to above was due to be published in draft form in July 2025. This was then delayed, with the draft eventually appearing in September 2025. The draft guidelines were very disappointing and did not meaningfully address our concerns, as discussed here.
As a registered stakeholder, we (X-PERT Health) submitted comments on the draft guidelines expressing our disappointment and setting out why we felt changes were needed and justified. Our co-authors of the open letter did the same.
The latest disappointment
Today (Wednesday 18th February), the final version of this update was published (you can see it here). Frustratingly, there were no meaningful changes in relation to our comments or concerns.
Our responses to the draft guidance were largely dismissed as being out of scope**, despite the commitments made by NICE in their original response to our letter. NICE’s responses were fairly generic and did not address many of our specific points or arguments.
Our comments, and NICE’s responses, can be viewed here.
Although disappointing, this outcome was not surprising. Indeed, it is what we predicted would happen in our previous blog (linked to above).
Next steps (and causes for optimism)
Our obvious next step is to reply to the letter NICE sent us in response to our open letter. This opened an avenue of communication which might help us seek some clarity on any plans NICE have to come good on the commitments they made.
The other main avenue to pursue was also referred to in our previous blog, which set out how we also submitted a form to the NICE surveillance team when our open letter was sent. The NICE surveillance team’s job is to keep an eye out for when guidelines might need updating. Their response to our submission confirmed that a review was planned, but (not unreasonably) set out how they wanted to see what changes were made as part of the ongoing update first. Now that update is over, I have contacted them to try and confirm their plans and proposed timelines.
Given NICE’s previous commitments in response to our open letter, the NICE surveillance team’s confirmation that a review was planned, and the general strength of the arguments around why an update is needed, I am optimistic that there is still a way forward.
So, what’s the bottom line?
Despite the issues with the existing NICE type 2 diabetes management guidelines being clear, and being acknowledged by NICE, no meaningful changes have been made to address them as part of the latest update. These recommendations are therefore still out of date, and are still inconsistent with most other relevant national and international guidelines.
There is some hope for the future though, including through following up on previous correspondence we have had with NICE (in which they committed to making changes), and through contacting the NICE surveillance team regarding their previously confirmed plans to conduct a review.
Although there is therefore some cause for optimism, this is tempered by concerns over how long it could still take before any changes are actually made, and frustrations that another opportunity has been missed to update the guidelines to better support people with type 2 diabetes to make lifestyle choices that are right for them.
* Specifically, they conflict with the NICE Overweight and Obesity Management guidelines (NG246), which are discussed here. This conflict is particularly important given the significant proportion of people with type 2 diabetes for whom NG246 is also relevant. Given the dietary advice in NG28 is outdated, we would recommend people follow the recommendations of NG246 (where relevant) instead.
** It is worth noting that we are not contesting that this is broadly true – as we set out in our previous blog on the subject, this update was always intended to focus on medicines. It is still a disappointing response though, particularly given our previous communications with NICE, the nature of the issues (including the conflict between NG28 and NG246), and the fact that relevant reviews of the literature were already available (e.g., from the development of NG246). There does not ultimately seem to be any reason they could not have made some changes, but rather it seems like they have taken the easy option to kick the can further down the road.
