NICE quality standards
National standards for diabetes care
Over the last two decades, the practice of physicians has been transformed by a growing evidence base quantifying the benefits and risks of interventions in diabetes and the development of clinical practice guidelines summarising this evidence base. The NICE quality standards for the management of diabetes were released in 2011, these were 14 statements that described what high quality care for patients should look like.
Statement 1. People with diabetes and/or their carers receive a structured educational programme that fulfills the nationally agreed criteria from the time of diagnosis, with annual review and access to ongoing education.
Statement 2. People with diabetes receive personalised advice on nutrition and physical activity from an appropriately trained healthcare professional or as part of a structured educational programme.
Statement 3. People with diabetes participate in annual care planning which leads to documented agreed goals and an action plan.
Statement 4. People with diabetes agree with their healthcare professional a documented personalised HbA1c target, usually between 48 mmol/mol and 58 mmol/mol (6.5% and 7.5%), and receive an ongoing review of treatment to minimise hypoglycaemia.
Statement 5. People with diabetes agree with their healthcare professional to start, review and stop medications to lower blood glucose, blood pressure and blood lipids in accordance with NICE guidance.
Statement 6. Trained healthcare professionals initiate and manage therapy with insulin within a structured programme that includes dose titration by the person with diabetes.
Statement 7. Women of childbearing age with diabetes are regularly informed of the benefits of preconception glycaemic control and of any risks, including medication that may harm an unborn child. Women with diabetes planning a pregnancy are offered preconception care and those not planning a pregnancy are offered advice on contraception.
Statement 8. People with diabetes receive an annual assessment for the risk and presence of the complications of diabetes, and these are managed appropriately.
Statement 9. People with diabetes are assessed for psychological problems, which are then managed appropriately.
Statement 10. People with diabetes at risk of foot ulceration receive regular review by a foot protection team in accordance with NICE guidance.
Statement 11. People with diabetes with a foot problem requiring urgent medical attention are referred to and treated by a multidisciplinary foot care team within 24 hours.
Statement 12. People with diabetes admitted to hospital are cared for by appropriately trained staff, provided with access to a specialist diabetes team, and given the choice of self-monitoring and managing their own insulin.
Statement 13. People admitted to hospital with DKA receive educational and psychological support prior to discharge and are followed up by a specialist diabetes team.
Statement 14. People with diabetes who have experienced hypoglycaemia requiring medical attention are referred to a specialist diabetes team.