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National Guidelines for Diabetes Care – Support for governance and management

These guidelines provide recommendations concerning the care of adults with diabetes. They are a revised version of the National Guidelines for Diabetes Care from 2010 and thus replace these.

Summary

These guidelines provide recommendations concerning the care of adults with diabetes. They are a revised version of the National Guidelines for Diabetes Care from 2010 and thus replace these. The recommendations concern targeted screening, prevention and lifestyle, glycaemic control, cardiovascular disease, nursing, diabetic complications and diabetes in pregnancy.

These guidelines contain a total of 140 recommendations, over fifty of which are of particular significance to the finances and organisation of the health service and to ensuring that people with diabetes receive a consistently high standard of care. These key recommendation are presented in this document – Support for governance and management.

The conclusions of these guidelines have been made on the group level. These guidelines also contain assessments of the recommendations' financial and organisational consequences, as well as monitoring indicators.

Some key recommendations

Preventing type 2 diabetes

The risk of developing type 2 diabetes can be reduced by interventions relating to diet and exercise, and interventions that lead to weight loss. The health service is therefore able to offer structured programmes that impact on lifestyle (diet and physical activity).

Women who have had gestational diabetes (reduced glucose tolerance that has appeared or been diagnosed during pregnancy) are at a greater risk of also developing diabetes later in life. The health service should therefore offer support in order to help women who have suffered from gestational diabetes change any unhealthy habits. The health service should also systematically monitor these women's weight, blood glucose and cardiovascular disease risk factors.

Preventing diabetic complications

Diabetic complications can be delayed or prevented by tackling the risk factors that are most strongly associated with the emergence of changes in the blood vessels. Consequently, the health service should invest in effective treatment for hypertension and treatment for hyperlipidaemia using statins. In addition, the health service should help those with diabetes to stop smoking and, if necessary, become more physically active.

The health service should also provide intensive blood glucose-lowering treatment in type 1 diabetes and newly diagnosed type 2 diabetes without known cardiovascular disease in order to achieve the best possible glycaemic control.

Losing weight has an effect on elevated blood glucose, hypertension and hyperlipidaemia. Non-surgical treatment for those who are overweight or obese reduces their weight by about five per cent over the course of one to two years, but does not usually lead to any permanent weight loss. Obesity surgery results in the loss of a large amount of weight over a long period of time, and in improved glycaemic control. Consequently, following careful clinical assessment, the health service should offer obesity surgery with structured follow-up to people with type 2 diabetes and severe obesity (BMI over 40 kg/m²). Surgery can also be considered for those with a BMI of 35–40 kg/m² in cases where there is a difficulty controlling blood sugars and risk factors.

Patient education

Educating patients in self-care has a key role in the care of people with diabetes. The health service should offer group-based patient education led by people who have expertise in the subject as well as the teaching skills needed to achieve the best possible results from treatment.

It is also important that self-care is adapted to the individual and takes into account any differences in their view of health and disease. Accordingly, the health service should also offer culturally adapted education in groups.

Glycaemic control

When improved dietary and exercise habits are not sufficiently effective in cases of type 2 diabetes, drugs are used to reduce the blood glucose level. The objective of treatment is to reduce the patient's symptoms and prevent complications such as damage to blood vessels and nerves. Metformin is the first-line drug of choice for treating type 2 diabetes. If the blood glucose level target is not achieved with metformin alone, the health service should offer other drugs in tablet form (repaglinide or sulphonylureas) and insulin – as monotherapy or as a complement to metformin.

Type 2 diabetes has a progressive course, which means that many patients end up requiring insulin therapy. Several types of treatment may then be appropriate. What is most common is a combination of tablets and intermediateacting basal insulin (NPH insulin) at bedtime. Longacting insulin analogues should only be offered when NPH insulin or biphasic insulin have been tried and when the patient has problems with repeated episodes of hypoglycaemia (blood glucose level too low).

Insulin pump therapy is an established form of treatment for type 1 diabetes and should be offered to people with type 1 diabetes who have recurrent episodes of hyper- or hypoglycaemia.

Inflammatory diseases of the tissues surrounding the teeth and dental implants (periodontitis) and deep root cavities are more common and often more serious among those with diabetes, which in turn can have a negative impact on their blood glucose level. Accordingly, it is important that the health service recognises that poor oral health is linked to glycaemic control, and that treatment for periodontitis and preventative interventions can have an impact on blood glucose levels comparable to that of some drugs.

Multidisciplinary foot teams

Multidisciplinary foot teams (i.e. foot teams consisting of several different professionals) have proved successful in dealing with serious foot problems and can, for example, result in fewer amputations. The objective of the care and treatment provided in cases of serious foot ulcers is to accelerate and achieve healing. This is dependent on the health service developing procedures for collaboration involving the members of the multidisciplinary foot team and primary care or home care services.

The consequences of these recommendations

The recommendations involve a general increase in the cost incurred the health service in the short term, but in some cases the interventions may also free up resources in the long term. Meanwhile the long-term costs are expected to increase as a result of the general increase in population, and because people are living increasingly long lives with disease thanks to improved control of risk factors. This assessments reflects the national level and the consequences may thus differ at the local and regional level.

Monitoring indicators

While drawing up these guidelines, the National Board of Health and Welfare has also revised and supplemented the existing indicators in the guidelines from 2010. The intention is for the indicators to reflect the most important recommendations in the guidelines and various aspects of consistent, high-quality care.

A selection of the indicators also have target levels, which state how great a proportion of a patient group should be considered for a certain investigation or achieve a target for a certain treatment. The target levels are used to support monitoring of the results at the local, regional and national level.

Read the full Summary

Year: 2015
Article number: 2015-4-12
ISBN: 978-91-7555-308-5
Format: POD
Pages: 120
Language: Engelska
Price (VAT included): 117 kr