Diabetes treatment


Outpatient and inpatient diabetes care delivery

Diabetes care is inherently complex – hence the need for 19 chapters of evidence review and recommendations in the Global Guideline. Pulling all the recommendations together to ensure the implementation of effective delivery of care therefore needs some organization of its own, as is discussed in this article. A special situation is that of people with diabetes in hospital, who are often subject to disruption of lifestyle due to illness, procedures, or surgery, with knock-on effects on their diabetes management.

National and regional organization: the key to effective diabetes care in Moscow

According to the federal statistics agency of the Russian Federation, the country’s population is in a phase of negative growth and currently stands at around 143 million. There are 2.3 million people registered with diabetes, 2 million of whom have type 2 diabetes. However, according to recent epidemiological research, there may be some 8 million people living with the condition in Russia. Success in addressing the problems relating to diabetes and its complications largely depends on the effective organization of diabetes care at regional and national levels.

Prevention of diabetes and its complications: key goals in Finland

The 10-year National Diabetes Programme in Finland (DEHKO) has been up and running for 6 years. The formal evaluations carried out to date indicate that the Programme continues to have a positive impact in a number of areas of diabetes care in Finland. Moreover, prevention of type 2 diabetes and cardiovascular complications remain the principle objectives of DEHKO. Timo Saaristo and Leena Etu-Seppälä report on FIN-D2D (2003-2007), the DEHKO project to implement primary prevention of type 2 diabetes in five regions – potentially affecting 1.5 million people.

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The relatively recent emergence in children of type 2 diabetes, a condition once considered ‘late-onset’, has been viewed with consternation around the world. Guidelines directed at healthcare professionals dealing with children have generally focused on type 1 diabetes; it is only now becoming apparent that type 2 diabetes in children is a serious condition and that it is at least as demanding to manage. The chapter on children in the Global Guideline seeks to raise awareness of these problems, which are faced by increasing numbers of families.


Diabetes increases the risks in pregnancy for both the mother and her infant. However, pre-pregnancy advice where possible, detection of undiagnosed or new (gestational) diabetes in pregnancy, and careful management of diabetes throughout pregnancy, with close liaison between healthcare professionals involved in diabetes, obstetric and neonatal care, can all help to achieve the desired outcome of a healthy mother and baby. The Global Guideline only addresses areas of pregnancy care that are commonly affected by the

Protecting eyesight, feet, and the nervous system

Classically, diabetes complications are thought of as damaging the heart and blood vessels, eyes, kidneys and nervous system. Blood vessel damage, together with nerve damage, leads to foot problems. Protection of the heart, blood vessels and kidneys is dealt with in an earlier article, as is protection of all of these by control of blood glucose levels. Here we describe how disabling problems which are developing in the eyes, feet, and nervous system despite those measures can be managed optimally.

Cardiovascular risk, blood pressure, and kidney damage

People with type 2 diabetes suffer badly from heart disease, strokes, and damage to the blood supply to their feet. Indeed, these cardiovascular conditions are the major causes of ill-health and death in people with the condition. A significant proportion of that ill-health is preventable, including by attention to the levels of fats and sugar in the blood, the clotting tendency of the blood, and blood pressure. Raised blood pressure is also responsible for worsening of eye damage and kidney damage in people with type 2 diabetes, and is therefore particularly well worth treating.