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Diabetes guidelines 2015

Type 2 diabetes is a chronic metabolic condition characterised by insulin resistance (that is, the body's inability to effectively use insulin) and insufficient pancreatic insulin production, resulting in high blood glucose levels (hyperglycaemia). Type 2 diabetes is commonly associated with obesity, physical inactivity, raised blood pressure, disturbed blood lipid levels and a tendency to develop thrombosis, and therefore is recognized to have an increased cardiovascular risk. It is associated with long‑term microvascular and macrovascular complications, together with reduced quality of life and life expectancy.

In 2013, over 3.2 million adults were diagnosed with diabetes, with prevalence rates of 6% and 6.7% in England and Wales respectively. It is estimated that about 90% of adults currently diagnosed with diabetes have type 2 diabetes. Type 2 diabetes is more common in people of African, African‑Caribbean and South Asian family origin. It can occur in all age groups and is increasingly being diagnosed in children.

This guideline contains recommendations for managing type 2 diabetes in adults, and focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long‑term complications. The guideline does not cover diagnosis, secondary diabetes, type 1 diabetes in adults, diabetes in pregnancy and diabetes in children and young people.

Reasons for the update

Since the publication of the 2009 guideline, availability of new evidence and several key developments have prompted an update in the following areas: managing blood glucose levels, antiplatelet therapy and erectile dysfunction. In particular, reasons included safety concerns surrounding some blood glucose lowering medicines, new evidence on new dipeptidyl peptidase‑4 (DPP‑4) inhibitors and glucagon‑like peptide‑1 (GLP‑1) receptor agonists, new indications and licensed combinations for licensed class members and the potential impact of drugs coming off patent on health‑economic issues. In addition, new evidence and safety issues relating to the off‑label use of antiplatelet therapy (aspirin and clopidogrel) in the primary prevention of cardiovascular disease motivated an update of this review.

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