Type 1 diabetes: diagnosis and management of type 1 diabetes in adults

National Institute for Health and Clinical Excellence

Key messages

Patient-centred care

• The views and preferences of individuals with type 1 diabetes should be integrated into their healthcare. Diabetes services should be organised, and staff trained, to allow and encourage this

Multidisciplinary team approach

• The range of professional skills needed for delivery of optimal advice to adults with diabetes should be provided by a multidisciplinary team. Such a team should include members having specific training and interest to cover the following areas of care:
  • education/information giving
  • foot care
  • nutrition
  • counselling
  • therapeutics
  • psychological care
  • identification and management of complications

Education for adults with diabetes

• Culturally appropriate education should be offered after diagnosis to all adults with type 1 diabetes (and to those with significant input into the diabetes care of others). It should be repeated as requested and according to annual review of need. This should encompass the necessary understanding, motivation and skills to manage appropriately:
  • blood glucose control (insulin, self-monitoring, nutrition)
  • arterial risk factors (blood lipids, blood pressure, smoking)
  • late complications (feet, kidneys, eyes, heart)

Blood glucose control

• Blood glucose control should be optimised towards attaining DCCT-harmonised HbA_1c targets for prevention of microvascular disease (less than 7.5%) and, in those at increased risk, arterial disease (less than or equal to 6.5%) as appropriate, while taking into account:
  • the experiences and preferences of the insulin user, in order to avoid hypoglycaemia
  • the necessity to seek advice from professionals knowledgeable about the range of available meal-time and basal insulins and about optimal combinations thereof, and their optimal use

Arterial risk-factor control

• Adults with type 1 diabetes should be assessed for arterial risk at annual intervals. Those found to be at increased risk should be managed through appropriate interventions and regular review. Note should be taken of:
  • microalbuminuria, in particular
  • the presence of features of the metabolic syndrome
  • conventional risk factors (family history, abnormal lipid profile, raised blood pressure, smoking)

Late complications

• Adults with type 1 diabetes should be assessed for early markers and features of eye, kidney, nerve, foot and arterial damage at annual intervals. According to assessed need, they should be offered appropriate interventions and/or referral in order to reduce the progression of such late complications into adverse health outcomes affecting quality of life