Evidence-base - International Diabetes Federation

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Consideration Cardiovascular risk protection for people with type 2 diabetes is an area of high need with good and strong evidence of interventions to meet that need. One obvious problem is the need to extrapolate evidence in some areas from groups of people who do not have diabetes, for example regarding smoking cessation. However, because event rates are much higher in people with diabetes (particularly with regard to primary prevention) the gains and costeffectiveness are also potentially much better, so that the risks of extrapolation of evidence are relatively low. This is especially true because the processes of arterial damage in people with type 2 diabetes are similar pathologically to those occurring in the general population, though usually present to a more abnormal degree. Accordingly, the recommendations are for very active management. Statin use is given prominence, as best founded in evidence. Although hypertriglyceridaemia and low HDL cholesterol are associated with poor outcomes, recommendations over use of fibrates for dyslipidaemia are still controversial because the evidence is either limited or the findings inconclusive. Aspirin is warranted for secondary prevention but its benefit in primary prevention is unclear. The results of the ongoing ASCEND trial, which is randomising 10,000 people with diabetes without pre-existing CVD to aspirin 100 mg and omega-3 fatty acids in a 2 x 2 factorial trial, should clarify its role in primary prevention [32] . Implementation The recommendations require access to measurement of a full lipid profile and supporting biochemistry, and to aspirin and statins as a minimum. Structured annual assessment and record-keeping should be instituted. Evaluation Evaluation is by achieved lipid levels, especially LDL cholesterol and triglycerides, and numbers of high risk people treated with statins and if appropriate, aspirin. In general, CVD outcome rates are difficult to assess except in very large populations. 11 CARDIOVASCULAR RISK PROTECTION 77
Global Guideline for Type 2 <strong>Diabetes</strong> 78 Potential indicators Indicator Denominator Calculation of indicator Percentage of people with type 2 diabetes with serum lipid measurement during past year. Percentage of people with type 2 diabetes with LDL cholesterol < 2.0 mmol/l (80 mg/dl). Percentage of people with type 2 diabetes with LDL cholesterol ≥ 3.0 mmol/l (115 mg/dl) not treated with lipidlowering medications. Percentage of people with type 2 diabetes who smoke. References Total number of people with type 2 diabetes seen in the past year. Number of people with type 2 diabetes seen in the past year and having at least one lipid profile measurement in the year. Number of people with type 2 diabetes with at least one lipid profile measurement in the past year and not on lipid-lowering treatment. Total number of people with type 2 seen in the past year. Number of people with type 2 diabetes with serum lipid measurement during past year as a percentage of people with type 2 diabetes seen in the past year. Number of people with type 2 diabetes with LDL cholesterol < 2.0 mmol/l (80 mg/dl) as a percentage of people seen in the past year, and with at least one lipid profile measured in the past year. Number of people with type 2 diabetes seen in the past year not treated with lipid-lowering medications and as a percentage of people with type 2 diabetes having at least one lipid profile measurement in the past year and a with an LDL cholesterol ≥ 3.0 mmol/l (115 mg/dl) . Number of people with type 2 diabetes seen in the past year who smoke as a percentage of the number of people with type 2 seen in the past year. 1. Haffner SM, Lehto S, Rönnemaa T, et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339: 229- 234. Data to be collected for calculation of indicator Documentation and date of serum lipid measurement. Most recent lipid profile including an LDL cholesterol result in the past year. Documentation and date of lipid profile measurement and lipid lowering medications. Documentation of smoking status.
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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
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2 CARE DELIVERY Recommendations Rec
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Evidence-base Systems underlying st
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Potential indicator Indicator Denom
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3 EDUCATION Recommendations Recomme
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The evidence from eight trials (six
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7 Mulcahy K, Maryniuk M, Peeples M,
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Page 34 and 35: Consideration People coping with di
Page 36 and 37: 18. van Bastelaar KM, Pouwer F, Cui
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Page 40 and 41: Implementation Recognition of the i
Page 42 and 43: 17. Banister NA, Jastrow ST, Hodges
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Page 46 and 47: Consideration The assessment/interv
Page 48 and 49: 7 CLINICAL MONITORING Recommendatio
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Page 54 and 55: 24. Mittman N, Desiraju B, Fazil I,
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Page 60 and 61: 9 GLUCOSE CONTROL THERAPY Recommend
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Page 66 and 67: as new evidence, particularly the r
Page 68 and 69: 6. International Diabetes Federatio
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Page 86 and 87: 12 EYE SCREENING Recommendations Th
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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
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Page 108 and 109: Limited care OPL1 The principles ar
Page 110 and 111: Diabetes is associated with an incr
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Evidence-base - International Diabetes Federation

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