Portal de Periódicos da CAPES

Global Guideline for Type 2 Diabetes

2014; Elsevier BV; Volume: 104; Issue: 1 Linguagem: Inglês

10.1016/j.diabres.2012.10.001

1872-8227

Diabetes Management and Education

There is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those with diabetes.Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefi t.Reasons include the size and complexity of the evidencebase, and the complexity of diabetes care itself.One result is a lack of proven cost-effective resources for diabetes care.Another result is diversity of standards of clinical practice.Guidelines are one part of a process which seeks to address those problems.Many guidelines have appeared internationally, nationally, and more locally in recent years, but most of these have not used the rigorous new guideline methodologies for identifi cation and analysis of the evidence.Many countries around the world do not have the resources, either in expertise or fi nancially, that are needed to develop diabetes guidelines.Also such a repetitive approach would be enormously ineffi cient and costly.Published national guidelines come from relatively resource-rich countries, and may be of limited practical use in less well resourced countries.In 2005 the fi rst IDF Global Guideline for type 2 diabetes was developed.This presented a unique challenge as we tried to develop a guideline that is sensitive to resource and costeffectiveness issues.Many national guidelines address one group of people with diabetes in the context of one healthcare system, with one level of national and health-care resources.This is not true in the global context where, although every health-care system seems to be short of resources, the funding and expertise available for health-care vary widely between countries and even between localities.Despite the challenges, we feel that we found an approach which is at least partially successful in addressing this issue which we termed 'Levels of care' (see next page).This guideline represents an update of the fi rst guideline and extends the evidence base by including new studies and treatments which have emerged since the original guideline was produced in 2005.Funding is essential to an activity of this kind.IDF is grateful to a diversity of commercial partners for provision of unrestricted educational grants. Levels of careAll people with diabetes should have access to the broad range of diabetes services and therapies and no person should be denied any element of effective diabetes care.It is recognised that in many parts of the developing world the implementation of particular standards of care is limited by lack of resources.This guideline provides a practical approach to promote the implementation of cost-effective evidence-based care in settings between which resources vary widely.The approach adopted has been to advise on three levels of care: Recommended care is evidence-based care which is costeffective in most nations with a well developed service base, and with health-care funding systems consuming a signifi cant part of national wealth.Recommended care should be available to all people with diabetes and the aim of any health-care system should be to achieve this level of care.However, in recognition of the considerable variations in resources throughout the world, other levels of care are described which acknowledge low and high resource situations.Limited care is the lowest level of care that anyone with diabetes should receive.It acknowledges that standard medical resources and fully-trained health professionals are often unavailable in poorly funded health-care systems.Nevertheless this level of care aims to achieve with limited and cost-effective resources a high proportion of what can be achieved by Recommended care.Only low cost or high costeffectiveness interventions are included at this level. CD4Agree a care plan with each person with diabetes.• Review this annually or more often if appropriate.• Modify it according to changes in wishes, circumstances and medical fi ndings. CD5Use protocol-driven diabetes care to deliver the care plan at scheduled routine visits between annual reviews. CD6Provide urgent access to diabetes health-care advice for unforeseen problems. CD7Organise care around the person with diabetes. CD8Use a multidisciplinary care team with specifi c diabetes expertise maintained by continuing professional education. CD9Ensure that each person with diabetes is recorded on a list of people with diabetes, to facilitate recall for annual complications surveillance. CD10Provide telephone contact between clinic visits. CD11Consider how people with diabetes, acting as expert patients, and knowing their limitations, together with local/regional/national associations, might be involved in supporting the care delivery of their local health-care team. CD12Use data gathered in routine care to support quality assurance and development activities. Care delivery RecommendationsRecommended care CD1Offer care to all people with diabetes, with sensitivity to cultural wishes and desires.