New IDF Guideline for managing type 2 diabetes in older people

Just over 8.3% of the global population has diabetes.1 Increasing age is a significant risk factor for type 2 diabetes but the diagnosis is often missed or delayed because the clinical presentation is different from that in younger people. Diabetes is a major cause of complications, reduced quality of life and changed physical and mental functioning in older people.2,3,4 It is also a leading cause of death in older people from cardiovascular and other related medical co-morbidities. In addition, many older people have additional risk factors for diabetes and may have undiagnosed complications.

Guidelines for type 2 diabetes - designed to help newly diagnosed children and adolescents

The prevalence of childhood obesity has increased dramatically worldwide with potentially dire consequences to the health of children and to their future. Drs. Warren Lee of Singapore and Stuart Brink of the USA introduce the new American Academy of Pediatrics guidelines for newly diagnosed type 2 diabetes in children and adolescents, explaining how the evidence-based recommendations are essential for all physicians involved in the care of children.

A world of challenges – and solutions

Welcome to the Autumn issue of Diabetes Voice. In this issue we continue our focus on the need for action to reverse the accelerating development of type 2 diabetes and obesity, with regions as far apart as Scandinavia and East Africa describing current activity with this goal. It is perhaps not surprising that despite major differences in language, lifestyles and per capita spending on healthcare, many of the problems – and their potential solutions – are shared.

IDF guideline on self-management of blood glucose

In October 2008, the IDF Task Force on Clinical Guidelines, in conjunction with the Self-Monitoring of Blood Glucose nternational Working Group, convened a workshop in Amsterdam to address the use of self-monitoring of blood glucose (SMBG) in people with type 2 diabetes who are not treated with insulin. The recently published guidelines on the use of SMBG in people with type 2 diabetes were developed based on the findings of that workshop. A summary of the findings and recommendations is provided in this article.

The results and implications of the ACCORD and ADVANCE trials

Recently, two clinical trials addressed the role of tight blood glucose control on cardiovascular risk in people with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the Action in Diabetes and Vascular Disease (ADVANCE) trial. The ACCORD study included 10,251 people with type 2 diabetes and was designed to determine whether intensive blood glucose control (HbA1c below 6%) as compared to a conventional approach (HbA1c between 7% and 7.9%) would result in favourable cardiovascular outcomes in people with type 2 diabetes at high vascular risk.

HbA1c results in relation to familiar every-day measurements - the near future

Haemoglobin A1c (HbA1c) is widely used to determine levels of long-term blood glucose, judge the adequacy of diabetes management, and adjust therapies. HbA1c results are expressed as the percentage of haemoglobin that is exposed to glucose (glycated). People’s day-to-day diabetes management is guided by self-monitoring of  capillary glucose concentrations, which are measured  in mmol/l or mg/dl.

Global standardization of the HbA1c assay - the consensus committee recommendations

Since the late 1970s, HbA1c test results have been used to guide diabetes care. The International A1c-AG Study, under way in 10 centres in North America, Europe, and Africa, aims to explore the relationship between HbA1c and average blood glucose. Martin Silink and Jean-Claude Mbanya, who represent IDF on a consensus committee working towards the standardization of the HbA1c assay, report on developments in the measurement and reporting of long- term average blood glucose levels.

The metabolic syndrome in children and adolescents: the IDF consensus

The importance of identifying children who are at risk of developing the metabolic syndrome cannot be underestimated. The syndrome is a cluster of risk factors

Guideline for the management of post-meal blood glucose

Diabetes is a leading cause of death in most developed countries, and has become a serious epidemic in many developing and newly industrialized nations. Currently, an estimated 246 million people worldwide have diabetes. Poorly controlled diabetes is associated with disabling and potentially life-threatening complications such as eye disease, kidney disease, nerve damage and cardiovascular disease. Until recently, lowering fasting and pre-meal glucose levels was a key focus of diabetes management.

Lifestyle and nutritional management

It is often stated that dietary management is a cornerstone of diabetes care. More recently, physical activity has also been recognized as a useful fundamental intervention. When it is realized that both of these can affect a variety of the problems that bedevil people with diabetes – including excess body weight, high blood glucose levels, high blood fat levels, and high blood pressure – it is not difficult to see why these issues might be regarded as fundamental.