Should NICE Align With ADA-EASD Guidelines for Diabetes?

Tim Locke

November 19, 2018

The Diabetes Professional Care conference in London has heard expert arguments as to why the National Institute for Health and Care Excellence (NICE) needs to update type 2 diabetes guidance to align with the recently announced American Diabetes Association and European Association for the Study of Diabetes (ADA-EASD) consensus.


Dr Samuel Seidu

The session was presented by Dr Samuel Seidu, head of research, Primary Care Diabetes Europe, and primary care research fellow in diabetes at the University of Leicester.

However, the head of guidelines for NICE said there are no plans to update its type 2 diabetes guidance yet.

NICE Guidance is OK, But They Need to Catch up…

Dr Samuel Seidu told Medscape News UK: "I think NICE is great. It’s a fantastic piece of guidance. If you look at it in detail, it's not actually very dissimilar to what we're talking about in the ADA-EASD consensus report.

"There are a lot of general statements, like consider the patient's individual circumstances.

"What it doesn't do is specifically talk about established cardiovascular disease.

"NICE doesn’t talk about this failing. So [ADA-EASD] actually changes the focus a bit. It makes it more colourful for the user. I think that's a big advantage.

"More specifically, I think the advantage of the ADA-EASD consensus is categorising patients in the various phenotypes - those who have established cardiovascular disease, those who have obesity as a concern, those who have hypoglycaemia as a concern, and in areas where cost is an issue. So there is something for everybody."


Dr Seidu said most clinicians in the diabetes sector will be able to cope with the differences in European and UK guidelines for now.

"It's a European guideline. And we're still in Europe despite Brexit. So we will follow it for those who know about it.

"For those who are in Scotland, they have SIGN (Scottish Intercollegiate Guidelines Network) which is a lot better. So it's not an issue.

"It's the standard GP practice nurse who doesn't know this. They will still go by the NICE guideline.

"So I think it is imperative that NICE catches up quickly. They don't have to do a new guideline every year. Just quick updates, like the Americans are doing.

"The ADA will update almost on a yearly basis."

He uses a building analogy when describing the different guidelines.

"NICE is focusing on HbA1c. If you've got a patient whose HbA1c is not well controlled, add X. If your HbA1c is still not well controlled, add Y. And so on and so forth, until you get to insulin.

"So that's like stacking bricks together. It doesn't tell you a story about a patient.

"However, if you look at the SIGN guideline, actually it moves a little better than that.

"It talks about adding the X and Y, what are the characteristics? What is the efficacy? Can I use that in a patient with renal impairment? Has it got cardiovascular benefit?

"So it's actually putting some colour, some more dimensions, to the uni-directional [approach] of NICE."

NICE Response

Dr Paul Chrisp, director, Centre for Guidelines at NICE wasn't in Dr Seidu's session, but spoke to Medscape News UK about whether NICE has plans to harmonise with ADA-EASD: "The short answer is no.

"The longer answer is, where the evidence base shifts significantly, we look at that, and we talk to topic experts, and we say on balance, do you think that this makes a material difference to any of the recommendations in our guidelines? And there's a number of outcomes from that conversation. One might be no, it just reinforces what we're already saying. Another might be, yes, in parts.

"So it might not be the whole guideline, it might be just a couple of recommendations. Or it might be, yes, it changes everything.

"We would always keep on top of important new evidence. And we will take a view as to how that affects our guidance. And in future we recognise we need to be more responsive to those changes.

“We can't wait months and years if there's something that everybody else is talking about in terms of 'this changes the game'.'"


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