This resource provides 10 clinically useful principles highlighting areas of agreement in diabetes prevention and management.
Updated in August 2018, ‘Guiding Principles for the Care of People With or at Risk for Diabetes’ aims to identify and synthesize areas of general agreement among existing guidelines to help guide primary care providers and health care teams to deliver quality care to adults with or at risk for diabetes. Sue Kirkman, M.D., and Judith Fradkin, M.D., discuss some of the updates reflecting new and changing evidence that has evolved over the last several years.
Dr. Kirkman: So there are a lot of diabetes guidelines out there and sometimes they compete in various ways. But I think what people forget is that many of the principles for taking care of diabetes - everyone agrees with.
Dr. Fradkin: Our point here is really to try to build on the guidelines that other groups have developed and find the elements that are common across all the guidelines - the areas in which there's general agreement.
Dr. Kirkman: Providing diabetes care is very difficult for providers, particularly primary care providers. And for them, diabetes might just be one condition that they're dealing with in that particular patient visit, which can be very short.
Dr. Fradkin: Guiding Principles are key principles that guide care providers in preventing and managing diabetes and, predominantly in this document, we're focusing on type 2 diabetes.
Dr. Kirkman: Guiding Principles are not guidelines. This is not an attempt to produce yet another guideline document. It's really just kind of a harmonization of what everyone agrees is good care for people with diabetes.
Dr. Fradkin: We had very broad input in the development of these Guiding Principles. We brought together representatives from the major diabetes and endocrine professional societies; also representatives from the major primary care societies: internal medicine, family practice, and geriatrics. So we brought together perspectives both of specialists and generalists - and it really helped to have both perspectives as we crafted the fine-tuning, the wording of the document.
Dr. Fradkin: We’ve learned a huge amount since the last time we put out the Guiding Principles. So, for example, the Food and Drug Administration required cardiovascular outcome trials for diabetes drugs and now we know that some drugs to lower blood glucose actually have some cardiovascular benefits. So, information like that is included.
Dr. Kirkman: Another thing that's different in this update is that we really focus more on individualization of care, and this has been something that's been evolving for the last five to ten years – that it's not one size fits all in diabetes, and we have more and more evidence that different people have different risk-benefit ratios in terms of treating diabetes.
Dr. Fradkin: It's really become increasingly evident that shared decision-making in which the patient helps to identify the goals and also helps to choose among the increasing array of options for prevention and treatment is much more likely to lead to an effective strategy to control diabetes and prevent complications. So we've included a lot of emphasis on motivational interviewing, shared decision-making, behavioral approaches, basically focusing on how to engage patients, because the treatment of diabetes goes well beyond medication and the patient is really the person who's managing his or her own diabetes.
Dr. Kirkman: So in addition to the writing group members who represented a number of different organizations, we also sent the draft Guiding Principles out for review to a number of NDEP partner organizations. So I really want to thank those organizations too, because in many cases they gave us really useful feedback and helped us make the document even better.
About the Authors
Sue Kirkman, M.D., is the current National Diabetes Education Program chair. She is also Professor of medicine in the Division of Endocrinology and Metabolism at the University of North Carolina, and medical director of the UNC Diabetes Care Center's Clinical Trial Unit.
Judith Fradkin, M.D., is director of the Division of Diabetes, Endocrinology, and Metabolic Diseases at the NIDDK. She plans and implements of a broad portfolio of basic and clinical research, including major clinical trials initiated or significantly co-sponsored by the NIDDK.