Managing diabetes effectively requires a comprehensive approach that encompasses lifestyle modifications, regular monitoring, appropriate medication, and proactive management of complications. The National Institute for Health and Care Excellence (NICE) provides detailed guidelines to help individuals with diabetes and healthcare professionals achieve optimal health outcomes.

Below, we present a structured summary of these guidelines, organized into key areas of diabetes management. Each section provides essential details and actionable steps to guide you through the management process. Whether you are newly diagnosed or seeking to refine your current management plan, these guidelines are designed to support your journey towards better health.

Here is a summary of the recommendations that you should know for the SCA Revision.

Summary Table

Lifestyle Management

Aspect	Details
Healthy Diet	Emphasize balanced nutrition, reduce saturated fats, refined sugars, and processed foods. Increase consumption of fruits, vegetables, whole grains, and lean proteins. Consider dietitian support.
Physical Activity	Aim for 150 minutes of moderate-intensity aerobic activity weekly. Include muscle-strengthening activities twice weekly. Tailor to individual capabilities.
Smoking Cessation	Support quitting smoking, including counselling and pharmacotherapy if necessary. Refer to cessation programs. Monitor progress.

Blood Glucose Monitoring

Aspect	Details
Self-monitoring of Blood Glucose	Regular monitoring, especially for insulin users. Log readings to identify patterns. Educate on glucometer use.
HbA1c Testing	Test twice a year for patients meeting goals, quarterly for those not meeting targets or with treatment changes. Aim for HbA1c ≤ 48 mmol/mol (6.5%).

Medication Management

Medication Class	Details
Metformin	First-line for type 2 diabetes. Start low, increase gradually. Monitor renal function.
Sulfonylureas	Consider if metformin is contraindicated or not tolerated. Risk of hypoglycaemia and weight gain. Examples: gliclazide, glimepiride.
DPP-4 Inhibitors	Add-on therapy when metformin alone is insufficient. Low risk of hypoglycaemia. Examples: sitagliptin, saxagliptin.
SGLT-2 Inhibitors	For patients with cardiovascular disease or high risk. Benefits in weight loss and blood pressure reduction. Examples: canagliflozin, empagliflozin.
GLP-1 Receptor Agonists	For significant weight loss or cardiovascular disease. Administer via injection. Low hypoglycaemia risk. Examples: liraglutide, exenatide.
Insulin Therapy	When oral medications and non-insulin injectables are insufficient. Start with basal insulin. Educate on injection techniques and hypoglycaemia management.

Cardiovascular Risk Management

Aspect	Details
Blood Pressure Control	Target < 140/90 mmHg or ABPM/HPBM < 135/85. Use ACE inhibitors, ARBs, calcium channel blockers, or thiazide-like diuretics. Regular monitoring.
Lipid Management	Use statins for cardiovascular disease prevention if QRisk >10%. Start at Atorvastatin 20mg if no previous CVD for primary prevention, otherwise start with Atorvastatin 80mg for secondary prevention. Aim for LDL < 2.6 mmol/L. Annual monitoring.
Antiplatelet Therapy	The guidelines say to no longer offer routine Aspirin or Clopidogrel for primary CVD prevention, unless advised by specialist.

Complication Screening and Management

Aspect	Details
Retinopathy Screening	Annual eye exams to detect diabetic retinopathy. Use fundus photography or dilated eye exams.
Nephropathy Screening	Annual urine albumin-to-creatinine ratio (ACR) check. Monitor serum creatinine and eGFR. Use ACE inhibitors or ARBs for microalbuminuria or proteinuria.
Neuropathy Screening	Annual foot exams to detect peripheral neuropathy. Test for loss of protective sensation. Educate on foot care.
Foot Care	Daily foot inspection for cuts, blisters, infections. Wear well-fitting shoes. Seek prompt medical attention for problems.

Specialist Referral

Specialist	Details
Endocrinologist	For complex cases or if glycaemic targets are not met despite optimal therapy. Type 1 diabetes or intensive insulin management.
Dietitian	Personalized nutritional counselling and meal planning. Address dietary concerns and improve adherence.
Diabetes Educator	Education on diabetes self-management, medication use, blood glucose monitoring, and lifestyle changes. Ongoing support.

For more in depth information, check the CKS NICE guidelines themselves.