Implications of the newly-published NICE guideline for type 1 diabetes

The National Institute for Clinical Excellence (NICE) has just published the guideline for type 1 diabetes. As with all of the other NICE guidelines, this is a fairly hefty document and is not suitable for light bedtime reading! Despite its size, this document is not the full guideline; this can be downloaded from the websites of the contributing organisations (National Collaborating Centre for Women’s and Children’s Health, 2004; National Collaborating Centre for Chronic Conditions, 2004).

The clinical information in the guideline has been presented in two main sections – one for children and young people (all those less than 18 years of age), reflecting their special needs, and the other for adults with type 1 diabetes. It is comprehensive and covers all relevant topics in some detail. Much of the information contained in these sections will not be new to diabetes specialist nurses and should serve as a useful summary of the quality of care required for individuals with type 1 diabetes. It is obviously not possible for this editorial to cover all the aspects detailed in the document, so I have mentioned some that may be more contentious or difficult to achieve, given current resources.

One comment is that diabetes centres are an important resource for enabling multidisciplinary teams to work and communicate efficiently and provide consistent advice. This implies that every health community should have one. As diabetes centres were not mentioned in the National Service Framework for diabetes and other priorities have necessarily been focused on over the last two years or so, this mention may help to ensure that diabetes centres are back on the agendas of those areas which do not have them. The guideline, therefore, also implies that the care of people with type 1 diabetes should be undertaken by specialist teams, rather than by primary care teams. This may cause consternation amongst some of the latter who are already providing diabetes care for all their people with diabetes, regardless of the type.

Another statement is that open access services should be available during working hours for adults with type 1 diabetes, on a walk-in or telephone request basis, as well as a 24-hour helpline staffed by people with specific diabetes expertise. Some innovative service redesign in my own organisation would be required to meet these recommendations without extra resources; for example, we have problems providing existing services when staff members are taking annual leave! However, in the new age of integrated care it could be possible, for instance, for primary care staff with an interest in caring for people with type 1 diabetes to develop their skills by working on a rotational basis with specialist staff in the diabetes centre to provide such services. They would thus acquire the diabetes-specific expertise from experience and be able to contribute to a 24-hour helpline for the locality.

Another useful section of the guideline is that discussing audit. Suggested criteria are given; it is proposed that these are used at trust level and as the basis for local clinical audits. As an example, it could be a helpful document for the increasing number of PCTs who wish to provide care for people with type 1 diabetes as well as those with type 2 diabetes, as there are very clear criteria against which to measure their services.

This document suggests that local health communities review their existing practice against the guideline and also consider the resources required to implement the recommendations. It therefore provides further ‘ammunition’ to help services try and acquire the resources they need to provide appropriate care for people with diabetes.