Global guidelines launched for Type 2 diabetes

The International Diabetes Federation (IDF) launched the first global evidence-based guidelines for Type 2 diabetes at the September meeting of the European Association for the Study of Diabetes, in Athens.

Diabetes afflicts more than 194 million people worldwide. "Estimates and projections agree that the number of diabetes cases that may be reached in the next 25 years would qualify as the largest epidemic humanity has ever experienced," said Philip Home, joint chair of the IDF Task Force on Clinical Guidelines. "IDF recognizes that immediate action is required, and by sharing evidence-based practice, we can help alleviate the burden by improving people's lives and reducing costs to healthcare systems."

Francine Kaufman, M.D., Keck School of Medicine of University of Southern California and Childrens Hospital of Los Angeles, served as a member of the guidelines group. The guidelines, she said, span all aspects of diabetes care and assimilate into one document the research and standards of nations worldwide. The real goal, she said, was to set forth a standard of care that every person on the planet with diabetes should be able to expect. Extensive evidence links the adequacy of diabetes management to short-term and long-term outcomes. The purpose of the IDF guidelines is to move individuals with diabetes, their healthcare systems, and perhaps even the political processes worldwide toward better care and ultimately better outcomes.

Although some components of the IDF guidelines are predictable (e.g., to maintain HbA_1c levels below 6.5% to minimize the risk of complications), others add detail to existing guidelines. The guidelines recommend beginning oral therapy with metformin unless there is evidence or risk of renal impairment. Data from a substudy of the United Kingdom Prospective Diabetes Study showed that metformin reduced the risk of vascular complications in overweight people with Type 2 diabetes and probably all people with Type 2 diabetes.

The guidelines structure recommendations according to three levels of care: standard care, minimal care, and comprehensive care-according to the resources available. "Obviously nations with a lot more resources could exceed those standards, and some nations would achieve even minimal standards with difficulty," Kaufman said.

Condit Steil, Pharm.D., CDE, associate professor of pharmacy practice at Samford University, McWhorter School of Pharmacy, and director of the Center for the Advancement of Pharmaceutical Care in Community Practice, Homewood, Ala., believes that pharmacists can use the IDF guidelines as benchmarks in their own practice.

"Clearly, the standards talk about follow-up care. Pharmacists are in a great position to provide this care to keep patients involved in their own self-care so they continue to do the things they should be doing. Through their knowledge about self-monitoring, the various devices, foot care, blood pressure checking, and skin care inspection, pharmacists can work with the patient in a community pharmacy and really make a difference," Steil concluded.

THE AUTHOR is a clinical writer based in the Indianapolis area.