Introduction
In the UK, approximately 4.6 million people have a diagnosis of diabetes.
Type 2 diabetes (where the body becomes resistant to insulin or does not make enough insulin) accounts for around 90 per cent of diabetes cases, and type 1 (where the pancreas produces little or no insulin), 8 per cent.
Common symptoms of type 2 diabetes are increased thirst, urinary frequency, blurred vision, recurrent infections, fatigue, and tingling or numbness in the hands or feet.
Complications
Poor diabetes control can cause a range of complications affecting multiple organs and body systems, including damage to the heart, blood vessels, eyes, kidneys and nerves. Cardiovascular disease (CVD) is the leading cause of death in people with type 2 diabetes.
There is data indicating that diabetes causes 680 heart attacks and 980 strokes every week in the UK, among other serious complications.
Without effective management, diabetes and associated complications contribute significantly to the UK’s healthcare burden. Around 60 per cent of the total cost of diabetes in the NHS is spent on managing its complications.
Major studies have, however, shown the benefits of good glycaemic control in delaying the onset of diabetes complications. There is also strong evidence that some glucose lowering medicines protect the heart and kidneys. Access to safe and effective treatment is therefore critical to reduce the risk of preventable complications and improve people’s quality of life.
Key facts
- New NICE guidance outlines a major shift in the management of type 2 diabetes from a glucose-centred approach to one that focuses equally on glucose, cardiovascular and renal risks
- Most newly diagnosed adults should receive modified release metformin and an SGLT-2 inhibitor (e.g. dapagliflozin) as first-line therapy
- Modified release metformin replaces standard release metformin to increase tolerability and adherence
- SGLT-2 inhibitors can be prescribed at the same time as metformin to reduce the number of health professional appointments
- SGLT-2 inhibitors will become much more widely used – and advising on side-effects and safe use will be crucial
- GLP-1 receptor agonists will be used earlier in specific patient groups.