Guidelines

The International Diabetes Federation (IDF) is not in the business of delivering clinical care to people with diabetes; but it is committed to the view that everyone with diabetes should benefit from the best possible care that could be available to them. One foundation of such care is to ensure that it is based on the best possible scientific knowledge. Here we describe the approach behind the recently published IDF Global guideline for Type 2 diabetes, an evidence-based guideline designed to assist care at different levels of resources.

The urgent need to tackle obesity and prevent type 2 diabetes is now widely acknowledged, particularly by the health ministers worldwide who in May 2004 gave their unanimous approval to the World Health Organization (WHO) Global Strategy on Diet, Physical Activity and Health. Many health ministries around the world have policies to cope with these most pressing public health issues. But their detailed strategies are often unclear. Indeed, almost everywhere, national programmes to address obesity and diabetes are still under development.

The metabolic syndrome is one of the major public health issues of our time. The International Diabetes Federation (IDF) believes that this cluster of factors is driving the twin global epidemics of type 2 diabetes and cardiovascular disease. If current trends continue, the premature deaths and disabilities resulting from these conditions will cripple the health budgets of many nations – both developed and

Over the last 10-15 years, various regional institutions in the Caribbean have developed protocols for the clinical management of diabetes. These have been used to improve the quality of care for people with the condition. However, the nutritional component of care was not adequately addressed in these recommendations and no standardized regional guidelines existed. Godfrey Xuereb reports on the development of a formal protocol for the nutritional management of diabetes and related conditions in the Caribbean region.

The measurement of glycated haemoglobin (as HbA1c ) is central to diabetes care. This is the measure by which health-care providers can relate blood glucose control to the risk of complications, such as eye damage or kidney failure. However, a lack of standardization in the methods used to measure glycated haemoglobin has produced wide variations among results and is among the current

People who have a kidney, liver or heart transplant are at high risk of developing diabetes. This can lead to cardiovascular disease and the rejection of the transplant. Factors such as age, weight and family history can increase the risk of new-onset diabetes after transplantation. Importantly, drugs that suppress the immune system and prevent transplant rejection also play a key role. In December 2003, an international panel of experts in transplantation and diabetes met to update the existing guidelines for the management of new-onset diabetes after

Obesity is rising rapidly in adult and child populations in virtually every part of the world. This brings with it a high risk of diabetes, heart disease and other serious conditions requiring expensive long-term medical care. In this article, Tim Lobstein and Philip James look at the role of governments in influencing what we eat. The authors propose ways in which governments can help to ensure that healthy diets are chosen over unhealthy ones.

“For forty-eight hours after admission to the hospital the patient is kept on an ordinary diet, to determine the severity of his diabetes. Then he is starved, and no food allowed save whiskey and black coffee. The whiskey is given in the coffee: 1 ounce of whiskey every two hours, from 7am until 7pm. The whiskey is not an essential part of treatment; it merely furnishes a few calories and keeps the patient more comfortable while he is being starved.” Starvation (Allen) Treatment of Diabetes (1915).

The Internet has become a useful tool that is relatively easy to operate. With little effort, huge amounts of information can be found about specific health conditions or health in general. Views and concerns about health can be shared with literally millions of other people; spreading health information to people around the world is a simple process. Clearly however, there is a need to evaluate this information

Results from a number of recent studies highlight the importance of psycho-social factors in diabetes management. Research shows that psychological co-morbidity is prevalent in people with diabetes. As a result, well-being, self-care and glycaemic control are adversely affected. Depression is common in people with diabetes, and