Australia’s first “living guidelines” for diabetes have been released for public consultation, with recommendations for medical devices for type 1 diabetes and drug choices for type 2 diabetes.

The draft guidelines, developed as an answer to the problem of guidelines rapidly becoming out of date and rescinded due to evolving evidence, have the ability to be continuously updated as new evidence arises.

They have been produced by Living Evidence for Diabetes Consortium, a collaboration between the Australian Diabetes Society (ADS), Diabetes Australia, the Australian Diabetes Educators Association (ADEA) and the Australasian Paediatric Endocrine Group (APEG).

Other stakeholders represented in the guidelines group include Cochrane Australia, the RACGP and the federal Department of Health.

“The objective of the Consortium is to develop a demonstration project in which the methods of Living Evidence are applied to select, priority areas of diabetes prevention, diagnosis and treatment. Resulting recommendations will be updated when new, relevant and impactful evidence is available,” the groups say.

In the first stage of the living guidelines, the Consortium has developed four recommendations for medical device technology for the management of type 1 diabetes (T1D):

• Continuous glucose monitoring (CGM) rather than self-monitoring of blood glucose for all adults with T1D treated with multiple daily injections.
• Continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) treatment for children and adolescents based on the preference of the person (and carer) with T1D.
• CSII rather than MDI treatment in adults with T1D.
• Automated CSII (AutoCSII) treatment rather than non-automated CSII treatment to optimise glycaemia for children, adolescents and adults with T1D.

The living guidelines also make seven recommendations on medications for blood glucose management in adults with type 2 diabetes (T2D):

• Metformin as first-line monotherapy in adults with T2D.
• Addition of an SGLT-2 inhibitor to other glucose lowering medication(s) in adults with T2D who also have cardiovascular disease, multiple cardiovascular risk factors and/or kidney disease.
• Addition of a GLP-1 receptor agonist to other glucose lowering medication(s) in adults with T2D who have cardiovascular disease, multiple cardiovascular risk factors and/or kidney disease, and are unable to be prescribed an SGLT-2 inhibitor due to either intolerance or contraindication.
• Addition of a DPP-4 inhibitor to other glucose lowering medication(s) in adults with T2D who have cardiovascular disease, multiple cardiovascular risk factors and/or kidney disease, and are unable to be prescribed an SGLT-2 inhibitor or a GLP-1 receptor agonist due to either intolerance or contraindication.
• Addition of either an SGLT-2 inhibitor, GLP-1 receptor agonist or a DDP-4 inhibitor to metformin in adults with T2D who do not have cardiovascular disease, multiple cardiovascular risk factors or kidney disease, and are unable to achieve optimal blood glucose levels.
• A sulphonylurea should not be the first choice medication to add to metformin as dual therapy in adults with T2D as it may increase the risk of severe hypoglycaemia.
• A thiazolidinedione should not be the first choice medication to add to metformin as dual therapy in adults with T2D as it may increase the risk of hospitalisation for heart failure.

Public consultation will run from Wednesday 5th August to Friday 4th September 2020