Pharmacological management of glycaemic control in people with type 2 diabetes

Diabetes is a major cause of morbidity and mortality in Scotland and worldwide, with an increasing prevalence. This increase relates, in part, to the increasing age of the population, an increase in obesity and also perhaps to increasing survival of those with diabetes.

Remit and target users

These guidelines provide recommendations based on current evidence for best practice in the management of diabetes.

SIGN 154: Pharmacological management of glycaemic control in people with type 2 diabetes provides recommendations on:

• optimal targets for glucose control for the prevention of microvascular and macrovascular complications in people with type 2 diabetes (moved unchanged from SIGN 116), and
• the risks and benefits of the principal therapeutic classes of glucose-lowering agents and insulins currently available for people with type 2 diabetes who require measures beyond diet and exercise to achieve glucose targets (updated from SIGN 116).

An updated algorithm to guide the choice of first-, second- and third-line glucose-lowering agents which incorporates the summarised evidence and the clinical experience of the guideline development group is included.

SIGN 116: Management of diabetes provides recommendations on: lifestyle interventions for type 1 and type 2 diabetes; managing psychosocial issues; managing type 1 diabetes; managing cardiovascular, kidney and foot diseases; preventing visual impairment; and managing type 1, type 2 and gestational diabetes during pregnancy. Prevention of diabetes and prediabetes are not covered.

These guidelines will be of interest to healthcare professionals involved in the management of people with diabetes, including diabetologists, diabetes specialist nurses, general practitioners, pharmacists and practice nurses. They will also be of interest to people with diabetes and their carers, voluntary organisations and policy makers. The target users for SIGN 116 also includes those who interact with people with diabetes outside of the NHS, such as parents and teachers.

How these guidelines were developed

SIGN 116 was developed using a standard methodology based on a systematic review of the evidence. Further details can be found in SIGN 50: A Guideline Developer’s Handbook. SIGN 154 was developed using a rapid review process based on SIGN’s standard methodology.

Keeping up to date

SIGN 116 was issued in 2010 and was considered for review after three years. SIGN 154 was issued in 2017 and was considered for review in 2022. The review history, and any updates to the guideline in the interim period, are noted in the review report.

​Current 3-7 years

Some recommendations may be out of  date, declaration of interests governance may not be in line with current policy.