Guidelines are an essential component of achieving quality care for all people with diabetes. Guideline recommendations define standards for care, and use evidence-based interventions to achieve those standards, in order to guide health professionals, people affected by diabetes, policy-makers and administrators.
IDF guidelines and position statements have been prepared to assist countries, organisations and individuals who wish to develop their own national and regional guidelines, and draw on the experience of experts from each of the IDF regions.
The full texts of these documents are available at www.idf.org
Clinical Practice Guidelines
The Guide for Guidelines has been written for all those involved in the care of people with diabetes; for those about to prepare guidelines to assist in the delivery of diabetes care; and for those who wish to draw on the experience of others in developing such guidelines.
Management of Post-meal Glucose
The purpose of the IDF Guideline for Management of Post-meal Glucose is to present data from reports that describe the relationship between post-meal glucose and the development of diabetes complications. Based on these data, recommendations for the appropriate management of post-meal glucose in type 1 and type 2 diabetes have been developed.
Oral Health for People with Diabetes
The International Diabetes Federation and the World Dental Federation came together to address whether the evidence base in this area allowed formal recommendations on oral health and diabetes care to be made. The result of the collaboration between the two organisations is the IDF Guideline on Oral Health for People with Diabetes.
Pregnancy and Diabetes
This guideline deals with the means of identifying women for whom such problems are new, and helping them, as well as women already known to have diabetes, to achieve the desired outcome of a healthy mother and baby.
Self-monitoring of Blood Glucose in Non-insulin Treated Type 2 Diabetes
The IDF Guideline on Self-monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes presents a summary of the findings and recommendations related to the use of self-monitoring of blood glucose in non-insulin treated people with type 2 diabetes.
Type 2 Diabetes
Global Guideline for Type 2 Diabetes takes into account 19 specific healthcare domains and includes topics of importance and controversy. It takes a stepped approach focusing on levels three levels of care: standard care, minimal care, and comprehensive care. These can be scaled and adapted to fit the needs of different resources in different settings.
Position and Consensus Statements
Animal, Human and Analogue Insulins
Insulins are now available in different molecular forms, some because of species differences and some by design through molecular engineering. There is no overwhelming evidence to prefer one species of insulin over another and patients should not be changed from one species of insulin to another without reason.
The International Diabetes Federation has released its Position Statement on Bariatric Surgery. The paper calls for bariatric surgery to be considered earlier in the treatment of eligible patients, to help stem the serious complications that can result from diabetes.
Diabetes and Cardiovascular Disease (CVD)
People with diabetes are two to six times more likely to develop cardiovascular disease than people without diabetes. IDF recognises the magnitude of this problem and strongly encourages all possible collaborative measures aimed at controlling the problem.
Diabetes and Kidney Disease
Kidney disease caused by diabetes is the commonest cause worldwide of kidney failure requiring treatment by dialysis or kidney transplantation. Early kidney damage can be detected by simple urine testing. The risk of kidney failure, and the rate at which it develops, can be reduced by good blood glucose and blood pressure control.
Diabetes and Obesity
Obesity and diabetes currently threaten the health, well-being and economic welfare of virtually every country in the world. IDF encourages those with responsibility for the provision of healthcare services to guarantee that all steps are taken to ensure that preventive measures are met.
Diabetes and Smoking
Tobacco is harmful to health and is of particular danger to people with diabetes. Smoking cessation has immediate positive effects, however it is made difficult by tobacco dependence and by all forms of advertising and promotion used by the tobacco industry.
Diabetes Self-Management Education
IDF believes that diabetes self-management education is a critically important, fundamental and integral component of diabetes prevention and care and should be available and accessible to everyone.
Integrated Prevention of NCDs
Statement made jointly by the International Obesity Task Force (IOTF) on behalf of the International Association for the Study of Obesity (IASO), the International Diabetes Federation (IDF), the World Heart Federation (WHF), the International Union of Nutritional Sciences (IUNS) and the International Pediatric Association (IPA).
The Diabetic Foot: Amputations are Preventable
People with diabetes are at risk of neuropathy and problems with ischaemia, both of which can lead to foot ulcers and slow-healing wounds which, if they get infected, may result in amputation. IDF recommends that every individual with diabetes receive the best possible foot care.
The Rights of the Child with Diabetes in the School
IDF is concerned about the situation of children with diabetes, especially in their school environment. IDF holds the position that children and adolescents must be able to manage their diabetes in the school setting without being excluded or discriminated.
The Role of Urine Glucose Monitoring in Diabetes
Blood glucose self-monitoring and urine glucose self-monitoring are the two primary methods used to monitor glucose levels. Urine glucose monitoring is not a substitute for blood glucose monitoring, but rather an alternative or complement which can provide very valuable information where blood glucose monitoring is not accessible, affordable, or desired.
Type 2 Diabetes in Young People
The prevalence of type 2 diabetes in children and adolescents is growing worldwide, and mirrors the increase of the condition in adults. IDF recommends that provisions be made to deliver the best possible care, prevent long-term complications, and promote further research.
Consensus on Type 2 Diabetes Prevention
Early intervention and the avoidance or delay of progression to type 2 diabetes is of enormous benefit to patients in terms of increasing life expectancy and quality of life, and potentially in economic terms for society and healthcare payers.
Worldwide Definition of the Metabolic Syndrome
This provides physicians with the tools to quickly identify those at risk and to compare the impact across nations and ethnic groups. The metabolic syndrome is a cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pressure.
HbA1c Working Group
The measurement of glycated haemoglobin (HbA1c) is central to diabetes care. This is a measure by which healthcare providers can relate blood glucose control to the risk of complications, such as eye damage or kidney failure. The working group was established to develop a standard and harmonise HbA1c reporting.
Sleep Apnoea and Type 2 Diabetes
Recent research demonstrates the likelihood of a relationship between type 2 diabetes and obstructive sleep apnoea (OSA). The IDF consensus statement on sleep apnoea and type 2 diabetes raises awareness of the association between the two conditions, which have significant implications on public health and on the lives of individuals.
HbA1c and the diagnosis of diabetes
In March 2009, the World Health Organization (WHO) convened a consultation to update the 1999 and 2006 reports on the diagnosis and classification of diabetes. The central issue was whether to recommend HbA1c as a diagnostic test for diabetes. The members of the expert group included experts in diabetology, biochemistry, immunology, genetics, epidemiology and public health. The expert group were to look at how HbA1c performed in the diagnosis of type 2 diabetes, based on the detection and prediction of microvascular complications. A systematic review of the issue was conducted by the Boden Institute of Obesity, Nutrition and Exercise, The University of Sydney, Sydney, Australia.
The recommendation was drafted by the expert group following the process outlined in the WHO Handbook for Guideline Development. The decision process took into account the findings of the systematic review and the advantages and disadvantages of using HbA1c to diagnose diabetes. The expert group concluded that HbA1c can be used as a diagnostic test for diabetes, provided that stringent quality assurance tests are in place and assays are standardised to criteria aligned to the international reference values, and there are no conditions present which preclude its accurate measurement.
An HbA1c of 6.5% is recommended as the cut point for diagnosing diabetes. A value less than 6.5% does not exclude diabetes diagnosed using glucose tests. The expert group concluded that there is insufficient evidence at this time to make any formal recommendation on the interpretation of HbA1c levels below 6.5%.
The higher cost of HbA1c measurement in comparison to other diagnostic tools will, for now, make it harder for low-income countries to use. The priority for low-income countries will continue to be ensuring the availability of blood glucose measurement at primary health care level before widely introducing HbA1c for diagnosing diabetes.
The full report is available from: http://www.who.int/diabetes/publications/report-hba1c_2011.pdf