Type 2 diabetes


Barriers to healthcare among homeless people with diabetes

It is estimated that about half of all homeless people suffer from chronic medical conditions. Unfortunately, these people frequently encounter many more barriers to care than the general population – exacerbating their health problems. The plight of homeless people with diabetes is particularly severe, since managing the condition requires adherence to a demanding care plan.

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President's Editorial


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.

Use of oral glucose-lowering drugs and insulin

It is important not to think of diabetes as being ‘treated’. And it is important not to think of diabetes management as being about lowering blood glucose levels alone. Other aspects of management are important enough to require separate chapters, both in the Global Guideline and in this Supplement. Nevertheless, the control of blood glucose is central to the management of type 2 diabetes, and nearly all people with the condition will need oral glucose-lowering drugs or insulin to help optimize this important cardiovascular risk factor.

Glucose control: measures, levels and monitoring

Blood glucose control is central to the very nature of diabetes, and the late complications which can develop. Unfortunately, it cannot be sensed by the person with diabetes unless levels are very high or very low. Accordingly, blood glucose control has to be measured reliably, and this needs to be done in the clinic and in normal life. Evidently, the results have then to be related to the risks of developing complications – hence targets and intervention levels.

The IDF 'Global Guideline for Type 2 Diabetes': background and methods

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. In this Supplement to Diabetes Voice we summarize in non-technical language the evidence base and recommendations of the IDF Global Guideline.