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Diabetes Mellitus - Guidelines

Checked: 19-12-2023 by Rob Adams Next Review: 18-12-2025

Principles of Management - Type 1 Diabetes Mellitus

The NICE Type 1 Diabetes Mellitus Guidelines were updated in 2020 and are summarised in Clinical Knowledge Summaries.

Please see BNSSG Type 1 Blood Glucose Monitoring Guidance (Primary Care) and Clinical Pathway for the use of diabetes technologies in all patients with Type 1 Diabetes in the Formulary section of Remedy

New diagnosis

To access a rapid assessment for patients with new onset Type 1 Diabetes Mellitus who do not require admission then please see the Rapid Access Clinic page.

Consider Diabetic ketoacidosis in patients with new onset diabetes and admit immediately to hospital if suspected.

Shared Decision Making

Leaflet to help explain to patients the options available to them in managing their Type 1 DM:

NHS England » Decision support tool: making a decision about managing type 1 diabetes

Type 2 Diabetes Mellitus

The NICE Type 2 Diabetes Mellitus guidelines were updated in 2022 and are summarised in Clinical Knowledge Summaries and have advice on diagnosis and management of Type 2 diabetes.

Please see the Formulary section of Remedy for guidelines on Blood Glucose Management in Type 2 Diabetes, BNSSG Type 2 Diabetes Blood Glucose Monitoring Guidance (Adults) and Clinical Pathway for the use of diabetes technologies in all patients with Type 2 Diabetes.

Diabetes Pathway

Community services (Sirona)

See the Community Diabetes Specialist service page for advice on referral pathways in the community.

Secondary care

UHB - Refer to the Diabetes Flow Pathway provided by UHB for advice on when to refer to secondary care.

Prescribing in diabetes

Please see the BNSSG formulary for advice on prescribing for patients with diabetes.

This page has information and advice on appropriate prescribing for:

Oral diabetic medication
Insulin use in type 1 and type 2 diabetes
Diabetes monitoring
Treatment of hypoglycaemia
Use of SGLT-2 Inhibitors in T2DM - Please see the BNSSG formulary for a link to guidelines on when SGLT-2 inhibitors should be considered for use in primary care. Please note that local renal physicians advise that there may be a dip in eGFR after starting SGLT2 inhibitors, and (in most cases) the recommendation is not to routinely test for this dip. If a dip in eGFR is observed incidentally then do not stop treatment without discussion with the heart failure team. A fall in eGFR of 25% from previous baseline may warrant discussion.

Frailty and Type 2 Diabetes

Refer to the Diabetes and Frailty - Guideline on Management of patients with Type 2 Diabetes

These guidelines give advice on management of diabetes in frail patients where the normal HbA1c targets may not be appropriate. The key aim of treatment in frail patients or those nearing end of life is avoidance of hypoglycaemia and hyperglycaemia which can increase hospital admissions, aggravate co-morbidities and reduce quality of life. The above guidelines give pragmatic advice on how to manage this group of patients.

Self-Management Guidelines

Please see Leaflets to support self-management.- links to Sirona patient info library, Hypo explained, Type 2 and steroids, what to do when you are ill (type 1 and type 2)

Diabetes UK

Sick Day Rules

BNSSG Sick Day Rules guidelines are available in the Formulary section.

Resources

NICE guideline [NG17] - Type 1 diabetes in adults: diagnosis and management (Last updated: 17 August 2022)

NICE guideline [NG28] - Type 2 diabetes in adults: management (Last updated: 29 June 2022)

Diabetes and Ramadan | Fasting | Diabetes UK

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.