This article compares new guidance for the management of diabetes from the Scottish Intercollegiate Guideline Network (2010) with the NICE (2009) clinical guideline for the management of type 2 diabetes. Both guidelines share the same approach to diabetes care but the algorithms for type 2 diabetes highlight subtle differences in the recommended management of blood glucose levels. This article explores the background to the development of the SIGN guidance and suggests possible reasons for the differences between the two algorithms. ...

The authors compared the diagnosis of type 2 diabetes using an HbA1c cut-off point of ≥6.5% (≥48 mmol/mol) with current World Health Organization (WHO) criteria involving fasting plasma glucose and an oral glucose tolerance test. Diabetes was confirmed in 35% of Australian and 49% of UK participants using WHO criteria and a similar prevalence was obtained using HbA1c – 31% and 46%, respectively. Using HbA1c levels alone for diagnosis does not define the same people with diabetes as the WHO criteria. A considerable number of participants (38% of Australian and 49% of British) diagnosed with diabetes by WHO criteria would not have been diagnosed using a single HbA1c test. More consideration of the use of HbA1c as a screening test for diabetes is required. ...