Global Guideline for Type 2 Diabetes

The International Diabetes Federation's global treatment guideline for type 2 diabetes addresses the basic steps that doctors should take when evaluating a patient with diabetes. The global guideline suggests three levels of care based on varying levels of health-care resources, categorizing recommendations as standard care (for most nations), comprehensive care (for wealthy nations) and minimal care (for resource-poor nations). The guideline addresses treatment recommendations, screening and management of diabetes-related conditions, and diabetes in special populations, such as children and pregnant women.

Guideline Background

• The International Diabetes Federation global guideline for type 2 diabetes is a result of a group of doctors, nurses, diabetes educators and patients coming together to agree on the best course of treatment for diabetic patients worldwide. The expert group wrote the guideline document in 2005 and plans to review it every five years to make sure it stays current with clinical practice and scientific research.

Treatment

• The global guideline for type 2 diabetes identifies a target blood-glucose level of 6.5 percent or lower in order to reduce the risk of diabetic complications. Lifestyle management is the overarching first option and basic building block in managing blood-glucose levels; if a diabetic patient cannot achieve 6.5 percent or lower with lifestyle management alone, the guideline recommends adding oral glucose-lowering drugs, either metformin or sulfonylureas, alone or in combination therapy. Should the patient still fail to maintain a blood-glucose level of 6.5 percent or lower, the guideline recommends the addition of thiazolidinedione, although this may not be an option for poorer nations. A doctor may also add insulin therapy separately or in combination with glucose-lowering drugs.

  Beyond tight control of blood-glucose levels, though, the guideline authors also recommend incorporating strong patient-education programs, consideration of the psychological effects of a diabetes diagnosis on a patient, assistance with lifestyle management and suggestions on clinical and self-monitoring of blood glucose.

Screening and Management of Diabetes-Related Conditions

• The global guideline for type 2 diabetes also addresses the screening and management of conditions that plague diabetics around the world, such as heart and kidney disease, damage to the nerves and blood vessels, foot sores and eye problems. Appropriate management of blood pressure is the underlying solution to many of these problems, and the guideline recommends regular evaluation of the patient's blood pressure to prevent complications. Screening of eyes, feet, nerves, kidney and heart at regular intervals also helps reduce the risk of developing other conditions.

Diabetes in Special Populations

• Given the increasing incidence of type 2 diabetes in younger women and the decision of many women worldwide to postpone having children, the guideline addresses the specific problem of increasing rates of gestational diabetes, diabetes in pregnancy. Recommendations separated by pre-pregnancy counseling, management during pregnancy, considerations during labor and delivery, and needs after delivery all focus on close monitoring of weight gain, glucose control and blood pressure to prevent complications to mother or child.

  The guideline also notes the growing problem of childhood obesity leading to more and more type 2 diabetes in children worldwide, especially in poorer countries. The global guideline focuses its recommendations on a whole-family approach and grounds treatment in lifestyle changes to avoid future complications as an adult.