Implementation of Nice Guidance for the Treatment of Type 2 Diabetes

Abstract

To assess implementation of National Institute for Health and Care Excellence (NICE) guidance for type 2 diabetes by comparing drugs prescribed for patients with a glycated haemoglobin, HbA1c, of ≤59 mmol/mol and patients with an HbA1c of ≥60mmol/mol. An analysis of drug treatments for type 2 diabetes patients was conducted using The Health Improvement Network database (THIN) for January-December 2016. NICE guidance recommends a treatment target for HbA1c of 58 mmol/mol (7.5%) above which drug treatment should be intensified; on first intensification dual therapy is recommended with metformin and a dipeptidyl peptidase-4 inhibitor (DPP-4), pioglitazone, a sulphonylurea (SU) or a sodium/glucose cotransporter 2 inhibitor (SGLT-2); on second intensification triple therapy is recommended and the introduction of an insulin based therapy. The 2016/17 Quality and Outcomes Framework includes targets for HbA1c of 59, 64 and 75 mmol/mol. Of 15,550 patients in the THIN database with a recorded HbA1c level, 11,296 (72.6%) were ≤59 mmol/mol and 4,254 (27.4%) ≥60mmol/mol. Of the ≤59 mmol/mol group 58% were taking metformin, 13% a sulphonylurea, 7% insulin, 5% DPP-4 inhibitors, <2% SGLT-2 inhibitors and <1% pioglitazone. Over 90% of uncontrolled patients (HbA1c ≥60mmol/mol) were taking metformin, 37% a sulphonylurea, 27% insulin, 15% DPP-4 inhibitors, 11% SGLT-2 inhibitors and 3% pioglitazone. No more than 66% of uncontrolled patients are taking intensified therapy as recommended by NICE and 27% are taking insulin. Uncontrolled type 2 diabetes is seen in 27.4% of patients recorded in the THIN database, lower than nationally reported estimates. Up to 34% of uncontrolled patients with type 2 diabetes may not be receiving treatment according to NICE guidance.