Diabetes - management and treatment

This section signposts key resources which provide guidance and recommendations on the management and treatment of diabetes in general.

It also highlights resources specific to two main categories of treatment: lifestyle and medication and insulin.
 
You will find further resources to support aspects of self-care and self-management at Patient involvement.

You may also want to refer to National standards and guidance.

The resources are listed under the following headings:

These resources were last accessed on 30 October 2012. Some of them are in PDF format - see how to access PDF files.

Key general resources 

Cochrane Library Database of Systematic Reviews

Cochrane Review: Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings
Different systems have been proposed to manage diabetes care. This review investigates the effects of different interventions, targeted at health professionals or the structure in which they deliver care, on the management of patients with diabetes in primary care, outpatient and community settings.
For further information about Cochrane reviews see How to use the Cochrane Library.    

Diabetes UK:15 healthcare essentials checklist
This checklist details the important aspects of diabetes that should be checked at least once a year. The results of tests and examinations can be discussed as part of the annual or six-monthly care planning review. This also provides an opportunity for people with diabetes to shape their care plan to individual needs and targets.

NICE Diabetes
NICE (National Institute for Health and Clinical Excellence) is an independent organisation responsible for developing evidence-based clinical guidelines, public health guidance, technology appraisals, quality standards and pathways. This section of the NICE website brings together all diabetes related guidance. 

this includes:

NICE Pathways: Diabetes overview
The pathway brings together the relevant NICE guidance and related resources and aims to provide fast access to these.
Managing type 1 diabetes. This includes pathways for children and young people and for adults with type 1 diabetes. Managing type 2 diabetes. This includes sections on blood-glucose-lowering therapy for type 2 diabetes, managing blood lipids and managing blood pressure. 

NICE Quality standards
Quality standards for the NHS define best clinical practice for the treatment and prevention of different diseases and conditions. They set out concise statement designed to drive and measure priority quality improvements within the particular area of care.
Diabetes in adults
This quality standard covers the clinical management of diabetes in adults. For further details of guidance published by NICE see the section on national clinical guidelines and standards in National standards and guidance: England.

International Diabetes Federation (IDF) (2005): Global guideline for type 2 diabetes
This global guideline attempts to address some of the difficulties of providing optimal management of type 2 diabetes in an international context, given the complexities of diabetes care and taking into account different health care systems and resource levels. It does this by providing advice according to three levels of care  - standard care, minimal care and comprehensive care.

RCN: eHealth: Telehealth and telecare
Telecare is increasingly being used in diabetes care. This section of the RCN eHealth resource provides general information about telehealth and telecare and their potential benefits and impact.
There is also a learning area within the RCN learning Zone for practitioners who are looking at the potential for and implementation of telehealth - see Telehealth explained [you will need to access this with your RCN membership number].

RCN Learning Zone: Diabetes essentials
This learning area is designed to provide an overview of the core concepts of diabetes; diagnosis and current treatments and roles and responsibilities in regard to treating patients with diabetes. It is relevant to all registered nurses, student nurses, midwives and health visitors, health care assistants (HCAs) and assistant practitioners working in any health care setting or nursing specialism.

Scottish Intercollegiate Guidelines Network (SIGN) (2010) Management of diabetes (SIGN publication number 116)
This updates the guideline 55 published in 2001 incorporating all the new evidence published since then. The guideline includes recommendations for lifestyle interventions, for the management of cardiovascular, kidney and foot diseases and for the prevention of visual impairment. Specific advice for pregnant women with diabetes is provided. There are new sections on psychosocial issues and on glucose-lowering therapies in people with type 2 diabetes.

Issues for inpatient care

Joint British Diabetes Societies for Inpatient Care Group (2012) Self-management of diabetes in hospital (PDF 2.6MB)
The guidance emphasises that the choice to continue to self-manage during admission should lie with the patient and should remain with the patient at all stages unless there is a specific reason not to. It looks at how the decision can be integrated with the rest of hospital care to provide safe and effective management of diabetes in hospital. Nine recommendations are made. The guidance is made available on the NHS Diabetes website.

NHS Diabetes (2012) Glycaemic management during the inpatient enteral feeding of stroke patients with diabetes
 This guidance aims to assist UK healthcare professionals in the management of enteral feeding in people with diabetes who have had a stroke.  “When inpatients with diabetes who have suffered a stroke are fed by the enteral route, the management of hyperglycaemia should be balanced against the risks of hypoglycaemia. Hypoglycaemia during the rest period between feeds is a potentially life-threatening event, and close monitoring of the patient is recommended at all times".

NHS Diabetes (2011) Management of adults with diabetes undergoing surgery and elective procedures: improving standards (PDF 6.2MB)
NHS Diabetes commissioned these guidelines to improve the management of adults with diabetes undergoing surgery and elective procedures. The guidelines cover all stages of the patient pathway from primary care referral to surgical outpatients, pre-operative assessment, hospital admission, surgery, post-operative care and discharge. The roles and responsibilities of each group of healthcare professionals at each stage of the patient's journey are outlined. The document provides the evidence base for the recommendations made. It discusses the factors leading to adverse outcomes, the metabolic response to surgery for the patient with diabetes, and controversial areas of care.
Also available are Summary guidelines (PDF 454KB).

NICE quality standard: Diabetes in adults: Quality statement 12: Inpatient care
NICE quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care.

Nursing Standard article:

Holt P (2012) Pre and post-operative needs of patients with diabetes. Nursing Standard 26(50) 15 August pp.50-56.
This article in the Nursing Standard continuing professional development series describes specific pre and post-operative care of patients with type 1 and type 2 diabetes and considers issues around potential effect on blood glucose control, diabetes-related complications and how they might impact on patient safety during surgery.
You can access the full text of this article via the RCN e-library at E-journals. 

For further resources relevant to management and treatment see