New IDF Guidelines on Diabetes Management
The International Diabetes Federation (IDF) announced the release of several new guidelines related to diabetes management at the IDF 20th World Diabetes Congress. These include the first-ever international guidelines on the management of diabetes in pregnancy and guidelines on the use of self-monitoring of blood glucose (SMBG) among Type 2 diabetic patients not being treated with insulin.
Pregnancy and Diabetes Guidelines Call for Universal Screening: Lois Jovanovič, MD, CEO and chief scientific officer of Sansum Diabetes Research Institute in Santa Barbara, California, and clinical professor of medicine at the University of Southern California-Los Angeles Medical Center, is one of the authors of the IDF Global Guideline on Pregnancy and Diabetes. The guidelines were created with evidence-based medicine.
"There was no international standard [for the diagnosis and management of gestational diabetes], said Dr. Jovanovič. "There was no consensus, there was a lot of confusion, women were suffering, and their pregnancy outcome was affected by having no standard by which to judge whether their diabetes was worth treating or not. This is the first time there is a worldwide consensus."
A key message of the new guidelines, according to Dr. Jovanovič, is the importance of universal screening. "Look for hyperglycemia in pregnancy," she said. "Preconceptional counseling [also] has to be universal.... For a [primary care] physician who has a [patient] in child-bearing years, the first question should be: Are you interested in getting pregnant again?"
Self-Monitoring of Blood Glucose in Noninsulin-Treated Type 2 Diabetes:
The IDF Guideline on Self-Monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes was developed in a manner similar to the IDF pregnancy guidelines. Their highlights include the following:
SMBG should be considered at the time of diagnosis but should only be used when patients, their caregivers, and/or their healthcare providers have the knowledge and willingness to incorporate findings into the diabetes management plan.
SMBG should be considered a part of ongoing diabetes self-management education.
SMBG protocols should be individualized.
Patients and their healthcare providers should agree on how to use SMBG data.
Tools used to measure SMBG must be easy to use and accurate.
Unique Features of Guidelines: Both sets of guidelines have key features that differentiate them from guidelines on the same topics put out by other diabetes associations, such as the American Diabetes Association (ADA), said Dr. Jovanovič.
"The ADA hopefully will change soon, but right now they don't subscribe to the philosophy of universal screening [in pregnancy]. They talk about selective screening. Our guidelines not only talk about universal screening but almost assume that every woman has diabetes [and] doing the testing is to reassure her that she doesn't. So, it's a paradigm shift. The second major difference is the [IDF] recommendation that it be a 1-step [oral glucose tolerance] test, not a 2-step test [as currently recommended by the ADA]. The ADA also have the criteria for diagnosis [of gestational diabetes] very high to minimize the number of women identified. The strategies in the [IDF] guidelines actually increase the number of women that would be identified and therefore offer treatment worldwide with one standard of care."
According to a coauthor of the SMBG guidelines, David Owens, MD, from the Cardiff University Diabetes Research Unit in the United Kingdom, a unique feature of the IDF SMBG guidelines is that they clarify the role of SMBG in diabetic patients who are not receiving insulin therapy. "For the noninsulin-treated individuals, [other guidelines] say that it's a good idea to incorporate SMBG ... but there is no real clarity as to what to do about it. That's where we've tried to extend the story more toward what the patient can do about it in their circumstances.... There are [other] guidelines that suggest that maybe there's no reason to monitor blood glucose in the noninsulin-treated, and they say that ... you need to look at the current evidence and see its limitations. Many of those publications are really not designed to ask [that] question."
International Diabetes Federation (IDF) 20th World Diabetes Congress: Abstracts 0498 and 0499. Presented October 22, 2009.