10 Guiding Principles for diabetes care published
The National Diabetes Education Program (NDEP) has published a set of 10 guiding principles for the care of people with diabetes mellitus.
The Guiding Principles for the Care of People With or at Risk for Diabetes have been published to unify the range of different guidelines that exist and cover the treatment of people with diabetes.
The guidelines are primarily aimed at health providers but have relevance to people with diabetes who wish to understand the health recommendations that apply to them.
The guideline, which covers 60 pages, is briefly summarised below:
- Identifying people with undiagnosed diabetes and prediabetes
With a focus on diagnosing people before symptoms appear, where possible, to reduce the likelihood of complications developing at an earlier stage.
- Managing people with prediabetes
Focusing on keeping to a low fat, low calorie diet, 150 minutes of exercise a week and to consider referral to registered dietitian or structured lifestyle intervention programme.
- Provision of diabetes self-management education (DSME) and support
People with diabetes should receive comprehensive DSME following diagnosis and at any other time education is needed
- Provision of individualized nutrition therapy
The guidelines recognize that diet modification can significantly lower HbA1c and that macronutrient intake should be tailored to the individual.
- Encouragement of regular physical activity
As physical activity improves a wide range of health markers, 150 minutes of exercise is recommended to include muscle strengthening exercises twice or three times per week.
- Control of blood glucose
A target of 6.5% or under is recommended in people with diabetes with less strict targets recommended for those for who may be at higher risk of severe hypoglycemia on more aggressive treatment regimens.
- Reduction of cardiovascular risk (heart disease and stroke risk)
Control of blood pressure, cholesterol levels and stopping smoking are focused on.
- Detection and monitoring of microvascular complications (nephropathy, neuropathy and retinopathy)
Screening for microvascular complications is recommended at, or soon after, diagnosis for all people with type 2 diabetes and within 3-10 years (depending on the complication) after diagnosis in type 1 diabetes.
- Consideration of special populations (including children, older adults, women of childbearing age and high-risk ethnic groups)
There is a greater need for the provision of individualized care in these groups.
- Provision of patient-centered care
Includes coordination of care, understanding individual challenges of each patient and developing individual care plans.
Whilst the guidelines are generally positive, the guidelines remain behind to the times, to a degree, in terms of the nutritional advice. Whilst a wealth of research has appeared to show that low fat diets are generally inferior (particularly in terms of blood glucose control) to low carbohydrate diets, the Guiding Principles continue to recommend low fat diets for people with diabetes.
One of the most positive aspects of the guidelines is in its recommendation of early screening for prediabetes and type 2 diabetes, to reduce the likelihood of complications developing at an early stage, and the recommended early screening of diabetic complications as well.
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