What does the National Institute of Clinical Effectiveness (NICE) recommend regarding the treatment of patients with type 2 diabetes?
The British NICE guidelines suggest good blood pressure control, metformin as initial treatment, daily aspirin, and statin treatment for most patients with type 2 diabetes (regardless of initial cholesterol level). These guidelines differ from the American Diabetes Association guidelines in that they are much more patient-centered and much less aggressive in their pursuit of sustained lower glucose levels. (LOE = 5)
Home P, Mant J, Diaz J, Turner C, on behalf of the Guideline Development Group. Management of type 2 diabetes: updated NICE guidance. BMJ 2008;336:1306-8. [PMID:3081394]
The NICE guidelines are derived from systematic reviews, supplemented, when minimal evidence is available, with recommendations based on expert opinion. Moving toward a more patient-centered approach that has not caught on the U.S., the organization recommends involving patients in setting targets for their individual A1c levels, blood pressure, and lipid levels. Based on moderate evidence and expert opinion, the recommend structured education based on the needs of the individual, delivered by trained educatiors. Nutrition advice should be offered as well. They suggest home (self) glucose monitoring only as an aid to education, with continual reassessment of its need for an individual. Other recommendations: 1) Blood pressure control should be addressed in patients with a confirmed blood pressure of >140/80 mmHg or >130/80 mm Hg with organ changes (high to moderate evidence). 2) Metformin should be first line treatment in most patients, following a trial of lifestyle changes and education (high quality evidence) 3) All patients with diabetes over the age of 50 years should receive daily aspirin, and younger patients with risk for cardiovascular disease (Moderate quality evidence) 4) Start statin treatment in most people at least 40 years old and in younger people with cardiovascular risk. Increase the dose to maintain a cholesterol less than 155 mg/dl (4.0 mmol/l) or low density lipoprotein <77 mg/dl (2.0 mmol/l). Based on high quality evidence. 5) Monitor albumin secretion, visual acuity, and neuropathic symptoms (expert opinion to high quality evidence)
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