Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the National Institute for Health and Care Excellence.

Management of Type 2 Diabetes in Adults

National Institute for Health and Care Excellence

Publication Date: Feb 18, 2026

Page Last Updated: Apr 8, 2026

1.2 Structured education programmes

1.2.1-Offer structured education to adults with type 2 diabetes and their family members or carers (as appropriate) at the time of diagnosis, with annual reinforcement and review. Explain to people that structured education is an integral part of diabetes care. [2009]
1.2.2-Ensure that any structured education programme for adults with type 2 diabetes:
- is evidence-based, and suits the needs of the person
- has specific aims and learning objectives, and supports the person and their family members and carers to develop attitudes, beliefs, knowledge and skills to self-manage diabetes
- has a structured curriculum that is theory driven, evidence-based and resource-effective, has supporting materials and is written down
- is delivered by trained educators who:
  - have an understanding of educational theory appropriate to the age and needs of the person
  - are trained and competent to deliver the principles and content of the programme
- is quality assured, and reviewed by trained, competent, independent assessors who measure it against criteria that ensure consistency
- has outcomes that are audited regularly. [2015]
1.2.3-Ensure that education programmes for adults with type 2 diabetes provide the necessary resources to support the educators, and that educators are properly trained and given time to develop and maintain their skills. [2009]
1.2.4-Offer adults with type 2 diabetes group education programmes as the preferred option. Provide an alternative of equal standard for people who are unable or prefer not to take part in group education. [2009]
1.2.5-Ensure that education programmes for adults with type 2 diabetes meet the cultural, linguistic, cognitive and literacy needs of people in the local area. [2009]
1.2.6-Ensure that all members of the diabetes healthcare team are familiar with the education programmes available locally for adults with type 2 diabetes, and that these programmes are integrated with the rest of the care pathway. [2009]
1.2.7-Ensure that adults with type 2 diabetes and their family members and carers (as appropriate) have the opportunity to contribute to the design and provision of local education programmes for adults with type 2 diabetes. [2009]

1.3 Dietary advice

1.3.1-Provide individualised and ongoing nutritional advice from a healthcare professional with specific expertise and competencies in nutrition. [2009]
1.3.2-Provide dietary advice in a form sensitive to the person's needs, culture and beliefs, being sensitive to their willingness to change and the effects on their quality of life. [2009]
1.3.3-Encourage adults with type 2 diabetes to follow the same healthy eating advice as the general population, which includes:
- eating high-fibre, low-glycaemic-index sources of carbohydrate, such as fruit, vegetables, wholegrains and pulses
- choosing low-fat dairy products
- eating oily fish
- controlling their intake of saturated and trans fatty acids. [2009]
1.3.4-For recommendations on low-energy and very-low-energy diets for the management of type 2 diabetes, follow the:
- NHS Type 2 diabetes Path to Remission Programme
- NICE guideline on overweight and obesity management. [2026]
1.3.5-Integrate dietary advice with a personalised diabetes management plan, including other aspects of healthy living such as increasing physical activity and losing weight (see the NHS Better Health website). [2009, amended 2026]
1.3.6 - Individualise recommendations for carbohydrate and alcohol intake, and meal patterns. Make reducing the risk of hypoglycaemia a particular aim for people using insulin or an insulin secretagogue. [2009]
1.3.7-Advise adults with type 2 diabetes that they can substitute a limited amount of sucrose-containing foods for other carbohydrates in the meal plan but should take care to avoid excess energy intake. [2009]
1.3.8-Discourage adults with type 2 diabetes from using foods marketed specifically for people with diabetes. [2009]
1.3.9-When adults with type 2 diabetes are admitted as inpatients to hospital or any other care setting, implement a meal planning system that provides consistency in the carbohydrate content of meals and snacks. [2009]
1.3.10 -For recommendations on wellbeing advice, see NICE's guidelines on overweight and obesity management, physical activity: brief advice for adults in primary care, and tobacco. [2015, amended 2026]

Targets

NICE has produced a patient decision aid on agreeing HbA1c targets, which also covers factors to weigh up when discussing HbA1c targets with patients.

1.5.5-Discuss and agree an individual HbA1c target with adults with type 2 diabetes (see recommendations 1.5.6 to 1.5.10). Encourage them to reach their target and maintain it, unless any resulting adverse effects (including hypoglycaemia), or their efforts to achieve their target impair their quality of life. Think about using the NICE patient decision aid on weighing up HbA1c targets to support these discussions. [2015, amended 2022]
1.5.6-Offer advice on healthy living, and medicines, to support adults with type 2 diabetes to reach and maintain their HbA1c target (see the sections on dietary advice, bariatric surgery, and person-centred medicines, and the NHS Better Health website). For more information about supporting adherence, see NICE's guideline on medicines adherence. [2015, amended 2026]
1.5.7-For adults whose type 2 diabetes is managed either by healthy living and diet, or healthy living and diet combined with an initial medication regimen that is not associated with hypoglycaemia (see the section on initial medicines), support them to aim for an HbA1c level of 48 mmol/mol (6.5%). For adults on a medicine associated with hypoglycaemia, support them to aim for an HbA1c level of 53 mmol/mol (7.0%). [2015, amended 2026]
1.5.8-In adults with type 2 diabetes, if HbA1c levels are not adequately controlled by the initial medication regimen and rise to 58 mmol/mol (7.5%) or higher:
- reinforce advice about diet, healthy living and adherence to medicines and
- support the person to aim for an HbA1c level of 53 mmol/mol (7.0%) and
- intensify medicines. [2015, amended 2026]
1.5.9- Consider relaxing the target HbA1c level (see recommendations 1.5.7 and 1.5.8 and NICE's patient decision aid on type 2 diabetes: agreeing someone's blood glucose (HbA1c) target) on a case-by-case basis and in discussion with adults with type 2 diabetes, with particular consideration for people who are older or frailer, if:
- they are unlikely to achieve longer-term risk-reduction benefits, for example, people with a reduced life expectancy
- tight blood glucose control would put them at high risk if they developed hypoglycaemia, for example, if they are at risk of falling, they have impaired awareness of hypoglycaemia, or they drive or operate machinery as part of their job
- intensive management would not be appropriate, for example if they have significant comorbidities. [2015, amended 2022]
1.5.10- If adults with type 2 diabetes reach an HbA1c level that is lower than their target and they are not experiencing hypoglycaemia, encourage them to maintain it. Be aware that there are other possible reasons for a low HbA1c level, for example deteriorating renal function or sudden weight loss. [2015]
1.5.11- For guidance on HbA1c targets in pregnancy, see NICE's guideline on diabetes in pregnancy. [2015]

1.7 Continuous glucose monitoring

1.7.1-Offer intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as 'flash') to adults with type 2 diabetes on multiple daily insulin injections if any of the following apply:
- they have recurrent hypoglycaemia or severe hypoglycaemia
- they have impaired hypoglycaemia awareness
- they have a condition or disability (including a learning disability or cognitive impairment) that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring but could use an isCGM device (or have it scanned for them)
- they would otherwise be advised to self-measure at least 8 times a day.
- For guidance on continuous glucose monitoring (CGM) in pregnancy, see NICE's guideline on diabetes in pregnancy. [2022]
1.7.2-Offer isCGM to adults with insulin-treated type 2 diabetes who would otherwise need help from a care worker or healthcare professional to monitor their blood glucose. [2022]
1.7.3-Consider real-time continuous glucose monitoring (rtCGM) as an alternative to isCGM for adults with insulin-treated type 2 diabetes if it is available for the same or lower cost. [2022]
1.7.4-CGM should be provided by a team with expertise in its use, as part of supporting people to self-manage their diabetes. [2022]
1.7.5-Advise adults with type 2 diabetes who are using CGM that they will still need to take capillary blood glucose measurements (although they can do this less often). Explain that is because:
- they will need to use capillary blood glucose measurements to check the accuracy of their CGM device
- they will need capillary blood glucose monitoring as a back-up (for example when their blood glucose levels are changing quickly or if the device stops working).
- Provide them with enough test strips to take capillary blood glucose measurements as needed. [2022]
1.7.6-If a person is offered rtCGM or isCGM but cannot or does not want to use any of these devices, offer capillary blood glucose monitoring. [2022]
1.7.7-Ensure CGM is part of the education provided to adults with type 2 diabetes who are using it (see the section on education). [2022]
1.7.8-Monitor and review the person's use of CGM as part of reviewing their diabetes care plan (see the section on individualised care). [2022]
1.7.9-If there are concerns about the way a person is using the CGM device:
- ask if they are having problems using their device
- look at ways to address any problems and concerns to improve their use of the device, including further education and emotional and psychological support. [2022]
1.7.10-Commissioners, providers and healthcare professionals should address inequalities in CGM access and uptake by:
- monitoring who is using CGM
- identifying groups who are eligible but who have a lower uptake
- making plans to engage with these groups to encourage them to use CGM. [2022]

1.9 Involving people in medicine discussions

NICE has produced a visual summary that provides an overview of the recommendations and additional information to support medicine choice up to the point at which a person starts insulin-based treatment.

1.9.1- Discuss dietary advice and other aspects of healthy living, such as increasing physical activity, alongside medicines to support adults with type 2 diabetes with their personalised diabetes management plan. For more information on how to achieve this see the:
- NHS Type 2 diabetes Path to Remission Programme
- NICE guideline on overweight and obesity management
- NHS Better Health website. [2026]
1.9.2-Discuss the benefits and risks of each medicine treatment option with adults with type 2 diabetes and support them to make an informed decision about their treatment. Take into account the:
- effect of each medicine on HbA1c and weight
- effectiveness of each medicine at preventing and managing cardiovascular and renal conditions
- factors that might prevent the person from following a specific treatment option (for example, pioglitazone is contraindicated for people with heart failure)
- cost: when more than 1 medicine from the same drug class are equally suitable for the person, use the least expensive. [2015, amended 2026]
- See also NICE's guideline on shared decision making and the section on safety of medicines for diabetes before and during pregnancy in NICE's guideline on diabetes in pregnancy.
1.9.3-If a person has more than one comorbidity (for example, atherosclerotic cardiovascular disease and obesity), make a shared decision with them about which comorbidity to prioritise when choosing medicines. Take into account:
- medicines required for cardiovascular and renal protection (for example, subcutaneous semaglutide for people with atherosclerotic cardiovascular disease)
- medicines that are contraindicated (for example, metformin for people with chronic kidney disease and an eGFR of less than 30 mL/min/1.73 m2)
- any other medicines they are taking and at what dose, particularly if the person has frailty (see recommendations for people with frailty in the initial medicines section).
- See also the recommendations on individualised care and NICE's guideline on multimorbidity. [2026]
1.9.4-When discussing GLP-1 receptor agonists and tirzepatide with women, trans men and non-binary people of childbearing potential, tell them:
- what Medicines and Healthcare products Regulatory Agency (MHRA) guidance on GLP-1 medicines for weight loss and diabetes says about the use of GLP-1 receptor agonists and tirzepatide in pregnancy and breastfeeding
- weight loss may improve fertility
- effective contraception must be used while taking the medicine
- that if they want to become pregnant, they should continue to use
- contraception for a period after stopping the medication (see MHRA guidance on GLP-1 medicines for weight loss and diabetes for specific length of time). [2026]
1.9.5-Use non-judgemental language in all medication discussions to support people with starting and adhering to treatment. For guidance on this, see NHS England's guide to language and diabetes [2026]

Document Overview

Document Title: Management of Type 2 Diabetes in Adults

Authoring Society: National Institute for Health and Care Excellence

Document Publication Date: Feb 18, 2026

Page Last Reviewed/Updated: Apr 8, 2026

Document Type: Guideline

Country of Publication: United Kingdom

Full Text Freely Available: Yes

Full Text Guideline: www.nice.org.uk/guidance/ng28/resources/type-2-diabetes-in-adults-management-pdf-1837338615493

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: This guideline covers care and management for adults (aged 18 and over) with type 2 diabetes. It focuses on education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications.

Scope: Assessment and Screening, Management, Treatment

Diseases/Conditions (MeSH)

D003920 - Diabetes Mellitus

D003924 - Diabetes Mellitus, Type 2

Keywords: diabetes, diabetes mellitus, type 2 diabetes mellitus

Target Patient Population: Adults (aged 18 and over) with type 2 diabetes

Target Provider Population: Primary care providers and allied clinicians caring for adults with Type 2 Diabetes Mellitus

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Data Supplement

Management of Type 2 Diabetes in Adults

Summary of Recommendations

Individualised care

1.1 Tailoring care to a person's needs

Education

1.2 Structured education programmes

Dietary advice and interventions

1.3 Dietary advice

1.4 Bariatric surgery

Blood glucose management

1.5 HbA1c measurement and targets

Measurement

Targets

1.6 Self-monitoring of capillary blood glucose

1.7 Continuous glucose monitoring

1.8 Hyperglycaemia

Person-centred medicine

1.9 Involving people in medicine discussions

1.10 Sick day rules

1.11 Assessing risk before starting medicines

1.12 Addressing inequalities in use of SGLT-2 inhibitors

Initial medicines

1.13 People with type 2 diabetes and no relevant comorbidities

1.14 People with heart failure (with any ejection fraction, unless specified)

1.15 People with atherosclerotic cardiovascular disease

1.16 People with early onset type 2 diabetes

1.17 People living with obesity

1.18 People with chronic kidney disease

1.19 People with frailty

How to introduce medicines

1.20 Introducing medicines in a stepwise manner

1.21 Preventing diabetic ketoacidosis when taking SGLT-2 inhibitors

Reviewing medicines

1.22 Principles

1.23 Reviewing metformin

1.24 Reviewing other medicines

Further medication

1.25 People with type 2 diabetes and no relevant comorbidity

1.26 People with heart failure (any ejection fraction unless specified)

1.27 People with atherosclerotic cardiovascular disease

1.28 People with early onset type 2 diabetes

1.29 People living with obesity

1.30 People with chronic kidney disease

1.31 People with frailty

Insulin-based treatments

1.32 Starting an insulin-based treatment

1.33 Choosing a type of insulin

1.34 Choosing a preparation

1.35 Reviews

1.36 Insulin delivery

Complications

1.37 Periodontitis

1.38 Gastroparesis

1.39 Painful diabetic neuropathy

1.40 Autonomic neuropathy

1.41 Diabetic foot problems

1.42 Erectile dysfunction

1.43 Eye disease

1.44 Diagnosing and managing hypertension

1.45 Antiplatelet therapy

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology