It’s good to see the NICE guidelines catching up

• NG17 – Type 1 diabetes in adults: diagnosis and management. The proposed update will focus on insulin therapy and management of complications.
• NG18 – Diabetes (type 1 and type 2) in children and young people: diagnosis and management. The proposed update will focus on measures to encourage screening for diabetic retinopathy and fluid and insulin therapy for diabetic ketoacidosis.
• NG28 – Type 2 diabetes in adults: management. The proposed update will focus on blood glucose management and management of complications.

This is long awaited and very much needed good news. The current type 2 management guidelines are at odds with the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) guideline that was discussed in a previous editorial (Davies et al, 2018). The ADA and EASD have taken a risk-stratification approach, suggesting that the presence of atherosclerotic cardiovascular disease, heart failure or chronic kidney disease should indicate which drug class should be considered after after metformin and lifestyle alone have failed to achieve target HbA_1c. The current NICE guideline was published in 2015 before we had the fast-growing evidence base regarding the cardio- and renoprotective effects of sodium–glucose cotransporter 2 (SGLT2) inhibitors, and indeed the cardioprotective effects of glucagon-like peptide-1 receptor agonists.

If NICE take the same risk-stratification approach for glucose management in type 2 diabetes, it should be easier for clinicians to make an evidence-based decision in a timely fashion and to have fully informed discussions with their patients when choosing the first and second intensification following metformin.

For the type 1 NICE guidance, the following areas will be reviewed:

• Flash glucose monitoring.
• Telemedicine.
• Smartphone apps and online platforms.
• Newer long-acting insulins.
• Biosimilar insulins.
• Use of SGLT2 inhibitor therapy as an adjunct to insulin therapy will also be considered.

The recent roll-out of national guidelines for the use of flash glucose monitoring has had a huge impact for those with type 1 diabetes and coincides with the recent update to the DVLA guidance for its use. In February, the DVLA (2019) updated its position on the use of continuous and flash glucose monitoring prior to driving (Box 1). Whilst this change only applies to Group 1 drivers, it is a huge step forward.

We now need to watch this space for the next stages of the NICE process and the draft guidelines, which could potentially have major implications for the care of people with diabetes. Good news indeed!
 
State of the Journal
This month also sees some good news for the Journal of Diabetes Nursing. Readers may have noticed a somewhat erratic publishing schedule over the last two years, especially in the first half of this year. The Journal’s mission to be a platform for all nurses working in diabetes, and to provide high-quality, peer-reviewed content free of charge is heavily dependent on support and sponsorship from the industry. Few publishers have been immune to the pharmaceutical industry’s tightening of budgets and regulations in recent years; however, we are pleased to finally see some new life being breathed into the journal.

For the rest of the year, at least, readers can expect more regular content and emails keeping you up to date. There may also be the occasional piece of sponsored content which, whilst not independent, we believe will nonetheless make interesting reading and viewing.

Readers of the old print version of the Journal will remember the themed special sections, and we are pleased to be bringing these back. Our first section, on diabetes and dementia, will be published soon, so look out for the email towards the end of the month!