Diabetes Guidelines

Dr Angela Murphy replies :

Doctors, or other health care providers, will use their academic knowledge, clinical experience and consensus when making that all important decision of how to treat the patient in front of them.  Today many of fields of medicine use guidelines as well.  Guidelines are released after careful research and collaboration of many experts in the field who look at the evidence for therapies available.

The American Diabetes Association, the European Association for the Study of Diabetes and the International Diabetes Federation are sentinel voices in the world of diabetes.  South African guidelines have been drawn up by the Society for Endocrinology, Metabolism and Diabetes South Africa (SEMDSA). Recommendations are set for the standardization of:

• Diagnosis of diabetes
• Targets for glucose control
• Targets for other conditions such as blood pressure and cholesterol
• Recommendations for lifestyle intervention
• Recommendations for medication

Diabetic guidelines have traditionally centered around increasing medications to get the patient to the target glucose control measured by HbA1c.  in the last few years, the emphasis has shifted.  Newer classes of diabetic medications (GLP1-receptor agonists and SGLT2-inhibitors) available have shown benefit to the patient with diabetes beyond blood glucose lowering.  These medications have shown that they can decrease the risk of cardiovascular disease and chronic kidney disease.

The International Diabetes Federation (IDF) state that up to 41% of people with Type 2 diabetes have cardiovascular disease which includes heart attack, angina, stroke and blockage of the arteries in the legs (peripheral arterial disease).  New diabetic guidelines suggest that the medications that can decrease these complications, as well as lower HbA1c, should be used early in the course of diabetes management.  However, newer medications are always more expensive, so our South African guidelines must take cost effectiveness into consideration too.