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The Health Products Regulatory Authority 

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The Health Products Regulatory Authority 

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The Health Products Regulatory Authority

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Our role is to protect and enhance public and animal health by regulating medicines, medical devices and other health products.

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

For information on related topics see our diabetes summary page.

In June 2022, we reviewed the evidence and made new recommendations on periodontitis.

Recommendations

This guideline includes recommendations on:

For recommendations on hypertension in people with type 2 diabetes, see the NICE guideline on hypertension in adults.

Who is it for?

Healthcare professionals

Commissioners and providers

Adults with type 2 diabetes, and their families and carers

Is this guideline up to date?

Updates in progress: Drug therapy (excluding insulin-based treatments): see the December 2024 guideline update page.

Portfolio review in May 2023: We have reviewed our guidelines portfolio to identify topics that we think will add the most value to the health and care system and have agreed the update on insulin therapy recommended in this surveillance report will not proceed as planned.

Guideline development process
How we develop NICE guidelines
This guideline updates and replaces:

NICE guidelines CG66 (published May 2008) and CG87 (published May 2009)

NICE technology appraisal guidance 203 and 248

NICE evidence summaries ESNM20, ESNM26 and ESNM59.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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

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Chronic Obstructive Pulmonary Disease (COPD) is a disease that makes it hard to empty air out of your lungs. This is because the airways get smaller leading to airflow obstruction. This can result in shortness of breath or tiredness because you are working harder to breathe.

COPD is a term used to include chronic bronchitis, emphysema or a combination of both conditions.

Chronic bronchitis is caused by inflammation and increased mucus (phlegm) in the breathing tubes (airways). Because of the swelling and extra mucus the inside of the breathing tubes become smaller causing obstruction in airflow.

Emphysema is caused by damage to the air sacs (alveoli) of the lung. Normally there are more than 300 million air sacs in the lungs. If the walls of the air sacs are damaged they lose their elasticity and trap air. This causes extra air to remain in the lungs after you breathe out. The extra effort required to breathe results in shortness of breath.

Most people with COPD are smokers or have smoked in the past. Sometimes COPD is caused by working or living for many years in an environment where there is exposure to smoke, dust or other fumes. COPD mostly affects those over the age of 35. An inherited condition called ALPHA - 1 - ANTITRYPSIN deficiency can also cause COPD but this is quite rare.
How your lungs work Symptoms of COPD
People can experience COPD in different ways depending on which symptoms trouble them most and how severe they are. COPD is a progressive illness meaning it has several stages of severity. It tends to creep up on people slowly. This means it can often be several years before symptoms reach a level that will make the sufferer go to the GP. Symptoms such as coughing, wheezing and shortness of breath are often attributed to getting older.

Mild COPD
Frequent coughing sometimes with mucus (phlegm)
Mild breathlessness from physical work or brisk walking

Moderate COPD
Coughing becomes more frequent and more mucus is produced
Breathlessness occurs more often from activities such as physical work or brisk walking
A cold or chest infection can last for several weeks

Severe COPD
Increased coughing and production of mucus
Difficulty breathing
You can no longer go to work or carry out household chores
Difficulty climbing a stairs or crossing a room
Tire very easily

The earlier COPD is diagnosed and treated the greater the chance of preventing it developing into severe COPD!
Diagnosis of COPD
If you answer yes to four or more of the following questions you should visit your doctor and ask to be tested for COPD

1. Do you cough several times every day?

2. Have you been coughing like this for more than three months?

3. Do you cough up mucus (phlegm) most days?

4. Do you feel breathless from physical work or moderate exercise?

5. Are you a current or former smoker?

6. Do you or have you ever worked in an environment where there is exposure to pollution, fumes, dust or smoke?

7. Is there a history of lung conditions in your family?

8. Are you over the age of 35?

COPD is diagnosed with a simple and painless breathing test called Spirometry. You will be asked to breathe as hard as you can into a machine. This measures the amount of air that you can force out of your lungs in one second and the total amount of air that you can force our of your lungs. From the results of this test you doctor will be able to tell if your airways have narrowed.

Further diagnostic tests that may be ordered by your doctor include:

Lung Function Tests indicate how much air your lungs can hold and how fast you can blow air in and out.

Arterial Blood Gas (ABG) is a special blood test that gives more information about your oxygen level and your breathing. This sample is obtained from an artery and not a vein.

Pulse Oximetry checks the oxygen level in your blood. This is done by placing a small probe on your finger.

6 Minute Walk Test checks your oxygen need while you walk. It also checks your capacity for exercise.

Electrocardiogram (ECG) shows the electrical activity of your heart.

Chest - X- Ray provides a picture of your lungs.

Computerised tomography (CAT Scan) is a non invasive, painless medical test that helps physicians diagnose and treat medical conditions.
Treatment of COPD
Smoking cessation is the first line of treatment for COPD

There are various types of medication that may be prescribed to treat COPD. Some of these include:

Bronchodilators

Corticosteroids

Antibiotics

Oxygen therapy

Vaccinations

Expectorants

Your medication may be taken in different ways. In order for the medication to work properly, you must take them as instructed, even when you are feeling better.

Bronchodilators help to relax and open your airways making it easier to breath. Bronchodilators are either short acting or long acting.

Combination inhalers contain both a reliever and a corticosteroid preventer. The action of the reliever is to keep the airways open, providing relief. The action of the corticosteroid preventer is to reduce inflammation in the lungs.

Oral Corticosteroids are high dose anti-inflammatories and can be used during a flare up for a short period of time. Occasionally some patients require a low maintenance dose.

Antibiotics are used to treat infections caused by bacteria.

Theophyllines are used in some patients who may require further bronchodilation (opening of the airways).

Expectorants can be used for patients who have excessive production of mucus, however not all patients benefit from this medication.

Vaccinations prevent lung infection from viruses and bacteria.

Pulmonary Rehabilitation is a multidisciplinary programme which involves doctors, nurses, physiotherapists, dieticians, occupational therapists, social workers and clinical psychologists. The programme covers exercise training, nutritional advice, education about your condition and offers counselling.

Watch a video on Pulmonary Rehabilitation with Dr. Tim McDonnell

Breathing Exercises are a key element in controlling the breathlessness associated with COPD. A physiotherapist will introduce you to breathing exercises. Pursed Lip Breathing works when you find it hard to breath. You can learn this now so you will not panic when you feel short of breath.

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Chronic Obstructive Pulmonary Disease (COPD) is a disease that makes it hard to empty air out of your lungs. This is because the airways get smaller leading to airflow obstruction. This can result in shortness of breath or tiredness because you are working harder to breathe.

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Overview | Asthma: diagnosis, monitoring and chronic asthma management | Guidance | NICE

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This guideline covers diagnosing, monitoring and managing asthma in adults, young people and children. It aims to improve the accuracy of diagnosis, help people to control their asthma and reduce the risk of asthma attacks. It does not cover managing severe asthma or acute asthma attacks

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engagement- empowering - shared decision-making