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IDF Issues Global Type 2 Diabetes Guidelines

Elizabeth Thompson Beckley

Recognizing that different regions have different resources for treating diabetes, the International Diabetes Federation (IDF) released the first Global Guideline for Type 2 Diabetes, September 13, at the 41st Annual Meeting of the European Association for the Study of Diabetes in Athens, Greece. "The guideline is globally applicable and it is sensitive to resource and cost-effectiveness," says Stephen Colagiuri, MD, of the University of New South Wales, Australia, and joint chair of the IDF Task Force on Clinical Guidelines. "It adopts a new and innovative approach by advising on three standards of care that can be applied, depending on the level of health care resources available."

Colagiuri acknowledges that there can be differing levels of care within one country. "The guidelines encourage people to assess where they're at, and then see where they need to improve," he says.

The three levels of care are:

• Standard—evidence-based care that is cost-effective in most nations with a well-developed service base and national health care funding systems consuming a significant part of national wealth;
  
• Minimal—the lowest level of care that anyone with diabetes should receive. Care that seeks to achieve major objectives of diabetes management, provided in settings with very limited resources;
  
• Comprehensive—care that includes the most current and complete range of technologies available, with the aim of achieving the best possible outcome. The evidence base for these expensive or new technologies may be relatively weak.
  

One example of the three-tier IDF guideline is clinical monitoring. Standard care calls for monitoring blood glucose by high-precision methods of testing glycated hemoglobin (A1C) every 2–6 months, depending on glucose control and change in therapy, and the availability of A1C levels before clinical consultation. The comprehensive care guideline is the same as for standard care, but continuous glucose monitoring is an additional option for people with consistent glucose problems. A1C levels would be available at each visit and provided to the patient in electronic or paper form. For minimal care, fasting plasma glucose could be used for monitoring.

"This document might be used to enable us to push our politicians to increase and improve the levels of care," says IDF task force joint chair Philip Home, MD, of the University of Newcastle upon Tyne, U.K.

The IDF Global Guideline recommends maintaining A1C <6.5%, citing evidence that a 1% reduction in A1C is associated with a 37% reduction in microvascular complications.

Eugene Hughes, MD, chairman of Primary Care Diabetes Europe, calls the 6.5% standard "daunting," but adds, "We need to embrace the opportunity this guideline gives us to deliver the best standard of care for all our patients, wherever they are."

Footnotes

FYI

The Global Guideline for Type 2 Diabetes can be ordered online at the International Diabetes Federation bookshop: www.idf.org.

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