Version 2.8, revision planned in 2012.

Last revised in July 2010

November 2010 — minor update. CKS is aware that some primary care trusts are still recommending gabapentin over pregabalin due to the significant price differences between these two drugs. Based on feedback from CKS external reviewers, gabapentin is also offered by CKS as an alternative to pregabalin if there is a local decision to prefer gabapentin over pregabalin for painful diabetic neuropathy. Issued in November 2010.

October 2010 — minor update. Information on fitness to drive from the Driver and Vehicle Licensing Agency's guidance for medical practitioners, At a glance guide to the current medical standards of fitness to drive has been added [DVLA, 2010]. Issued in October 2010.

September 2010 — updated. Rosiglitazone is no longer available: the UK marketing authorisation has been suspended because the benefits are no longer considered to outweigh the increase in cardiovascular risk associated with its use [MHRA, 2010b]. Issued in September 2010.

September 2010 — minor update. The Supporting evidence section on Antiplatelet drugs has been updated. Issued in September 2010.

August 2010 — minor update. The Medicines and Healthcare products Regulatory Agency (MHRA) has issued a reminder that the current cardiovascular restrictions on rosiglitazone must be followed whilst the European Medicines Agency review on the safety of rosiglitazone is ongoing [MHRA, 2010a]. Issued in August 2010.

July 2010 — updated to include new recommendations on the management of painful diabetic neuropathy from NICE (National Institute for Health and Clinical Excellence) published in the guideline Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings [NICE, 2010a].

June 2010 — minor update. Advice that vitamin B₁₂ deficiency may sometimes be caused by long-term treatment with metformin added to the Adverse effects section. Issued in June 2010.

April 2010 — minor update. The recommendations from the NHS Diabetes Working Group on when to recommend self monitoring of blood glucose (SMBG) has been included in the section on Self monitoring of blood glucose. It supports the advice that SMBG should only be offered with appropriate education and clear objectives in specific circumstances [NHS Diabetes, 2010]. Advice from SIGN that aspirin should not be offered for primary prevention of cardiovascular disease in people with diabetes has also been added [SIGN, 2010]. Issued in April 2010.

December 2009 — minor update. The recommendations on when to consider antiplatelet therapy for primary prevention of cardiovascular disease have been updated. Issued in December 2009.

July to October 2009 — updated to include evidence and recommendations from the National Institute for Health and Clinical Excellence (NICE) short guideline Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes [NICE, 2009b] and new information on reporting HbA_1c levels. A reminder from the Medicines and Healthcare products Regulatory Agency (MHRA) [MHRA, 2009e] that aspirin is not licensed for primary prevention of cardiovascular disease has also been added. Issued in October 2009.

July 2009 — minor update to clarify the advice from the Medicines and Healthcare products Regulatory Agency on the use of angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists in women who are breastfeeding [MHRA, 2009b]. Issued in July 2009.

May 2009 — minor update to include drug safety advice from the Medicines and Healthcare products Regulatory Agency on the use of angiotensin-converting enzyme inhibitors and angiotensin-II receptor antagonists in women who are breastfeeding [MHRA, 2009a]. Issued in June 2009.

April 2009 — updated to include the indicators related to diabetes mellitus in the Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) contract in the Goals and outcome measures section. Issued in May 2009.

March 2009 — minor update. Losartan has been reclassified as a black triangle drug by the Medicines and Healthcare products Regulatory Agency (MHRA). However, this is due to harmonisation of the Summary of Product Characteristics across the European Union, not because of any newly identified safety issues. Issued in April 2009.

July to December 2008 — converted from PRODIGY guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence.

This CKS topic replaces previous topics on Diabetes — foot disease, Diabetes — glycaemic control, Diabetes — hypertension, Diabetes — renal disease, and Diabetes — retinopathy.

Significant changes include:

• The recommendation to prescribe aspirin to all people with diabetes over the age of 50.
• The recommendation to start insulin (before triple therapy with oral antidiabetic drugs) in primary care, providing the expertise and support are available.
• The rapid-acting insulin secretagogues (nateglinide and repaglinide) are recommended as an alternative to sulphonylureas for people with irregular mealtimes. Prescriptions are included.
• Recommendations for management of hypertension have altered — all people with type 2 diabetes should now be started on an ACE inhibitor first-line (unless contraindicated).
• The decision on when to prescribe a lipid-modifying drug is more clearly expressed.
• Treatment targets for lipids have changed.
• Ezetimibe is now recommended, in addition to simvastatin, as an alternative to a higher intensity statin for people with cardiovascular disease or microalbuminuria who have not reached lipid targets on a lower-intensity statin. Prescriptions are included.