Type 2 diabetes

English

Pregnancy

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.

Treating the syndrome today and in the future

We can take advantage of the metabolic syndrome: it can be used as a simple and effective tool to assess health risks in people with type 2 diabetes and those without the condition. We can benefit from the universal availability of the tools needed to make a diagnosis – at no further cost. Given the excessive levels of death and disability suffered by people with type 2 diabetes and its associated conditions, it is of the utmost importance that early and appropriate steps are taken once a diagnosis of the metabolic syndrome is made. Fortunately, there

'Double diabetes' in young people and how to treat it

In most countries around the world, there has been an increase in the number of children and young people with diabetes. While in general it is relatively easy to distinguish whether a child or teenager has type 1 diabetes or type 2 diabetes, in some cases, young people have elements of both kinds of the condition. This new phenomenon has been labelled ‘double diabetes’ or ‘hybrid diabetes’. Francine Kaufman reports on the existence of double diabetes and the implications of this condition for the initial categorization and treatment of young people who are diagnosed with diabetes.

Glucose control: closing the gap between guidelines and practice

The Global Partnership for Effective Diabetes Management is a multidisciplinary task force of international diabetes experts. The group came together in 2004 with the objective of supporting improvements in treatment outcomes for people with type 2 diabetes. The aim of the Global Partnership was not to develop another set of guidelines, but to provide practical advice to help more people to achieve good glucose control.

A global guideline for type 2 diabetes: using a new 'levels of care' approach

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.

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