Evidence-base - International Diabetes Federation

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10 BLOOD PRESSURE CONTROL Recommendations Recommended care BP1 Measure blood pressure at least annually, and at every routine clinic visit in people with known CVD, if found to be above target blood pressure levels at previous visits (see below), or if on blood pressure lowering treatment. BP2 Measure blood pressure with a validated meter in good working order and an appropriately sized cuff (large or normal depending on arm size). Measure blood pressure after sitting for at least 5 minutes, with arm at heart level, using first and fifth phases of Korotkoff sounds. Use 24 hour ambulatory blood pressure monitoring (ABPM) if ‘white coat’ hypertension suspected, but adjust targets down by 10/5 mmHg. BP3 Consider secondary causes of raised blood pressure if there is evidence of renal disease, electrolyte disturbance or other specific features. BP4 Consider blood pressure lowering treatment if blood pressure is consistently above 130/80 mmHg. BP5 All people with known CVD should receive blood pressure lowering therapy unless contraindicated or not tolerated. BP6 Aim to maintain blood pressure ≤ 130/80 mmHg, if therapy is well tolerated. Revise individual targets upwards if there is significant risk of postural hypotension and falls. Higher targets should be used in the elderly (see Chapter 16: Older People). BP7 Initiate a trial of lifestyle modification with appropriate education (see Chapter 5: Lifestyle management), aiming to reduce energy intake, salt intake, alcohol intake and inactivity. BP8 In diabetes not complicated by raised albumin excretion rate any agent can be used as first line therapy except for a-adrenergic blockers, with consideration of costs, and actively titrating dose according to response. • Angiotensin converting enzyme-inhibitors (ACE-inhibitors) and angiotensin-II receptor blockers (ARBs) may offer some advantages over other agents in some situations, but do not use the two together (see Chapter 11: Cardiovascular risk protection and Chapter 13: Kidney damage). They are less effective in people of African extraction. • Calcium channel blockers (CCBs) should be avoided in congestive heart failure. • Use β-adrenergic blockers in people with 10 BLOOD PRESSURE CONTROL 65
Global Guideline for Type 2 <strong>Diabetes</strong> 66 angina; β-adrenergic blockers and ACE- inhibitors in people with coronary artery disease; ACE-inhibitors or diuretics in those with heart failure; ACE-inhibitor plus low dose thiazide or thiazide-like diuretic (indapamide or chlorthalidone), or ACE-inhibitor plus CCB in people with cerebrovascular disease. Care should be taken with combined thiazide and β-adrenergic blockers because of risk of deterioration in metabolic control. BP9 Add further medications from a different class if targets are not reached on maximal doses of current medications, reviewing for adverse effects and likely adherence problems as tablet numbers increase. The preferred combinations are: • ACE-inhibitor plus CCB. • ACE-inhibitor plus low dose thiazide or thiazidelike diuretic (indapamide or chlorthalidone). Accept that blood pressure target may not be achievable with three or more anti-hypertensive medications in some people. Limited care BP L 1 Principles for measurement and targets as for Recommended care. BP L 2 Initiate a trial of lifestyle modification as for Recommended care with appropriate education (see Chapter 5: Lifestyle management). BP L 3 Initiate medications for lowering blood pressure in diabetes not complicated by proteinuria, using generic ACE-inhibitors, ARBs, CCBs, diuretics or β-adrenergic blockers, according to availability and cost. Comprehensive care BP C 1 The principles as for Recommended care, but with the additional option of self-monitoring of blood pressure on validated semi-automatic devices to provide additional information and educational feedback. Rationale Blood pressure is elevated in many people with type 2 diabetes. Increasing blood pressure levels are associated with a spectrum of adverse outcomes, including premature mortality, CVD (cardiac disease and stroke), eye damage and kidney damage and treatment to lower blood pressure reduces these adverse outcomes. Blood pressure lowering in people with type 2 diabetes is highly cost-effective [1] .
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INTERNATIONAL DIABETES FEDERATION,
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Correspondence, and related literat
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Global Guideline for Type 2 Diabete
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Methodology The following methodolo
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GLOBAL GUIDELINE FOR TYPE 2 DIABETE
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1 SCREENING AND DIAGNOSIS Recommend
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Evidence-base Diabetes is associate
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Implementation A clear and transpar
Page 20 and 21: 2 CARE DELIVERY Recommendations Rec
Page 22 and 23: Evidence-base Systems underlying st
Page 24 and 25: Potential indicator Indicator Denom
Page 26 and 27: 3 EDUCATION Recommendations Recomme
Page 28 and 29: The evidence from eight trials (six
Page 30 and 31: 7 Mulcahy K, Maryniuk M, Peeples M,
Page 32 and 33: 4 PSYCHOLOGICAL CARE Recommendation
Page 34 and 35: Consideration People coping with di
Page 36 and 37: 18. van Bastelaar KM, Pouwer F, Cui
Page 38 and 39: Comprehensive care LS C 1 Advice on
Page 40 and 41: Implementation Recognition of the i
Page 42 and 43: 17. Banister NA, Jastrow ST, Hodges
Page 44 and 45: Glucose measurement Plasma glucose
Page 46 and 47: Consideration The assessment/interv
Page 48 and 49: 7 CLINICAL MONITORING Recommendatio
Page 50 and 51: The introduction of continuous ambu
Page 52 and 53: Evaluation There should be records
Page 54 and 55: 24. Mittman N, Desiraju B, Fazil I,
Page 56 and 57: Comprehensive care SM C 1 The princ
Page 58 and 59: Implementation Provision should be
Page 60 and 61: 9 GLUCOSE CONTROL THERAPY Recommend
Page 62 and 63: Comprehensive care GC C 1 The princ
Page 64 and 65: Outcomes studies compared with othe
Page 66 and 67: as new evidence, particularly the r
Page 68 and 69: 6. International Diabetes Federatio
Page 72 and 73: Evidence-base The evidence-base on
Page 74 and 75: Consideration Blood pressure manage
Page 76 and 77: Anglo‐Scandinavian Cardiac Outcom
Page 78 and 79: CV9 Consider other medications for
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Page 82 and 83: Consideration Cardiovascular risk p
Page 84 and 85: 2. Evans JMM, Wang J, Morris AD. Co
Page 86 and 87: 12 EYE SCREENING Recommendations Th
Page 88 and 89: hormone, anti-vascular endothelial
Page 90 and 91: diabetes population coverage. Evide
Page 92 and 93: 13 KIDNEY DAMAGE Recommendations Th
Page 94 and 95: Evidence-base CKD is defined as a g
Page 96 and 97: References 1. Kidney Foundation Dis
Page 98 and 99: 2. Evaluate footwear - provide appr
Page 100 and 101: The output from these documents is
Page 102 and 103: 15 NERVE DAMAGE Recommendations Rec
Page 104 and 105: disturbance, orthostatic hypotensio
Page 106 and 107: 16 OLDER PEOPLE Recommendations Thi
Page 108 and 109: Limited care OPL1 The principles ar
Page 110 and 111: Diabetes is associated with an incr
Page 112 and 113: 3. Brown AF, Mangione CM, Saliba D,
Page 114 and 115: 17 IN-PATIENT CARE Recommendations
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MDRD modification of diet in renal
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Disclaimer The IDF is not engaged i
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Evidence-base - International Diabetes Federation

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