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National service frameworks and strategies

Standards for diabetes care

Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. It can lead to complications including kidney failure, coronary heart disease, stroke, blindness and amputation. Read this introduction to diabetes to find out more about how diabetes occurs.

There are two main types of diabetes: type 1 and type 2.

Type 1 diabetes is most common in children and young adults and accounts for between 5% and 15% of all people with diabetes. Type 1 diabetes occurs when the body produces no insulin. The Health A-Z section has more information about type 1 diabetes.

Type 2 diabetes accounts for the vast majority of people with diabetes and is strongly linked to obesity. This form of diabetes can often be managed by just keeping up a healthy diet and lifestyle. More information about type 2 diabetes, including the causes and symptoms, can be found in the Health A-Z section of this website.

The diabetes national service framework (NSF)

The diabetes national service framework (NSF) was published in December 2001. It was the first-ever set of national standards aimed to develop a patient-centred service, improve health outcomes for people with diabetes in England, raise the quality of services and reduce unacceptable variations between them.

The National Institute of Health and Clinical Excellence (NICE) quality standard for diabetes

NICE has now published a Quality standard for diabetes (2011), which supports the existing NSF and provides an authoritative definition of good quality care. NICE quality standards enable the following to happen:

  • Health and social care professionals can make decisions about care based on the latest evidence and best practice.
  • Patients can understand what service they can expect from their health and social care providers.
  • NHS trusts can quickly and easily examine the clinical performance of their organisation and assess the standards of care they provide.
  • Commissioners to be confident that the services they are providing are high quality and cost-effective.

Identifying and preventing type 2 diabetes

Early intervention and treatment, especially in high-risk groups, can reduce or delay the onset of long-term complications of diabetes.

NHS Health Check

Collectively, vascular disease (heart disease, stroke, diabetes and kidney disease) affects the lives of more than four million people and kills 170,000 in the UK every year. These conditions also account for more than half the mortality gap between rich and poor. Modelling work undertaken by the Department of Health has found that offering the NHS Health Check to all people between the ages of 40 and 74 in England, and recalling them every five or 10 years would be a cost-effective and clinically beneficial programme.

The NHS Health Check assesses people’s risk of heart disease, stroke, kidney disease and diabetes by looking at their age, gender, family history, height and weight, as well as their blood pressure and cholesterol levels.

Everyone will receive a personal assessment, setting out personal levels of risk and strategies to reduce it. For those at low risk, this might be no more than general advice on how to stay healthy, weight management programmes or stop smoking services. Those at the highest risk might also require preventive medication with statins or blood pressure treatment.

NHS Health Checks have the potential to prevent 1,600 heart attacks and strokes and save up to 650 lives each year. They could prevent over 4,000 people a year from developing diabetes and detect at least 20,000 cases of diabetes or kidney disease earlier.


The Change4Life campaign was launched in 2009 as part of a strategy to help reduce obesity, which can result in type 2 diabetes, and to help people maintain a healthy weight. Aimed at families, it promotes messages such as healthy eating and being more active.

Managing diabetes

Supporting people with diabetes to understand their condition is an important part of the disease management. Structured education programmes, access to specialist diabetes advice, care planning discussions and annual checks are opportunities to identify necessary changes to treatment regimes and refer to specialist services.

There are currently two national patient education programmes designed to give people the skills and confidence to manage their condition. The Dose Adjustment for Normal Eating (DAFNE) is an educational programme which helps people with type 1 diabetes adjust their insulin injections to fit their lifestyles, rather than fitting their lives round rigid insulin regimes. The Diabetes Education & Self Management for Ongoing & Newly Diagnosed (DESMOND) provides a structured education programme for those with type 2 diabetes.

Care planning is an inclusive process that supports the ongoing partnership between healthcare professionals and people with diabetes. The process of agreeing a care plan offers people active involvement in deciding, agreeing and "owning" how their diabetes will be managed.

Annual check-ups

It is vital that people with diabetes receive all nine of the NICE recommended key health tests and measures. These tests help to monitor and manage the condition, as well as to reduce the risk of complications such as stroke, heart disease and amputations.

The nine annual health checks for people with diabetes are:

  • weight and BMI measurements
  • blood pressure
  • smoking status
  • blood test (HbA1c – blood glucose levels)
  • urinary albumin test (or protein test to measure the kidney function)
  • serum creatinine test (creatinine is an indicator for renal function)
  • cholesterol levels
  • eye check (retinopathy screening)
  • feet check

If you have diabetes and have not received all nine checks in the last year, talk to your GP or practice nurse.

Diabetes foot care

Diabetes can lead to serious complications and damage throughout the body if it is not well-managed, and in particular the eyes, kidneys and feet can be affected. Complications often occur when a person's blood sugar, blood pressure and blood fat levels are very high. This often happens slowly over time and you may not notice anything is wrong until it is too late. There are, on average, 73 lower limb amputations a week in England because of complications of diabetes, of which 80% are potentially preventable.

"Putting feet first", first published in 2009 by Diabetes UK in partnership with NHS Diabetes, is a best-practice guide to diabetes foot care. It aims to help local service providers to deliver high-quality foot care for people with diabetes. Visit Diabetes UK for more information. 

In March 2011, NICE issued its guidance on Management of diabetic foot problems – inpatient management, offering evidence-based advice on the inpatient care of people with diabetic foot problems from hospital admission onwards.

If you suspect there is anything wrong with your feet, for example, loss of sensation or wounds that do not heal, then seek medical advice because diabetic ulcers can develop very quickly. Find out more about diabetes and foot care.

Screening for diabetic retinopathy

When patients are diagnosed with diabetes, they should be offered diabetic retinopathy screening on an annual basis. The better that blood sugar levels are controlled, the less chance there is of developing serious eye problems. Having an annual eye check by a specialist (an ophthalmologist or an optometrist) can help pick up signs of any potentially serious eye problems early on, so that they can be treated.

Also watch the videos on: 

Pre-conception advice for women with pre-existing diabetes

Diabetes can cause a range of problems in pregnancy, during delivery and for the baby after birth. Of particular concern is the increase in birth defects in this group. Effective pre-conception care can reduce these risks. NICE lists pre-conception care as a "key priority" to improving pregnancy outcomes in women with diabetes.

All women with type 1 or type 2 diabetes considering pregnancy should be referred for pre-conception care to a specialist service.

You can find more information about diabetes and pregnancy on the pregnancy care planner.

Inpatient care for people with diabetes

People with diabetes may be admitted to hospital for reasons related or unrelated to the condition. In hospital, responsibility for the management of diabetes should be shared between the patient and the health professionals. Good diabetes control is important for a speedy recovery and early discharge.

For further information, download the Diabetes UK’s guidance on What diabetes care to expect (PDF, 230kb).


Page last reviewed: 12/07/2011

Next review due: 12/07/2013

Diabetes key facts

In the UK, diabetes affects approximately 2.8 million people. More than one million people are thought to have undiagnosed type 2 diabetes.

There are approximately 23,000 children with diabetes in England. The vast majority of which have type 1 diabetes.

Type 2 diabetes is five times more common in black and minority ethnic groups and three times more common in areas if social deprivation.

Find diabetes support services in your area

Diabetes: reduce your risk

African Caribbean people are more at risk of diabetes. Find out about symptoms and how to reduce your risk

Video: gestational diabetes

Get expert advice about gestational diabetes and find out how Kimberly managed her pregnancy after she was diagnosed with the condition.

Diabetes blood test

In this video, an expert explains what the diabetes blood test is used for, and why the reporting system changed in 2009.

Media last reviewed: 20/02/2013

Next review due: 20/02/2015