Rikken B
Ned Tijdschr Geneeskd. 2006 Oct 14;150(41):2233-4.
The publication of the practice guideline 'Diabetes mellitus' by the Dutch College of General Practitioners in 1989 marked the start of an era of publication of several guidelines that helped general practitioners using evidence-based medicine in clinical practice; the guidelines also helped to teach students. The second revision of this guideline presents many improvements, especially simplifications in the medication-schedules. However, the new recommendation to use thiazolidines is based on only one large study and has some unpractical aspects. The new guidelines do not mention preventive action, nor advice regarding early detection. Clinical practice has changed in recent years with the introduction of nurses specialising in diabetes and, despite published research on this subject, the guidelines do not give any recommendations for this. What is also missing are national clinical guidelines for doctors specialising in internal medicine. When patients do not respond to treatment according to the general practitioners' guidelines and are referred to a specialist in internal medicine, the treatment is diverse and seems to be doctor-dependent. It is important that treatment there be standardised as well so that general practitioners can refer more effectively.
荷兰全科医生学院于1989年发布的《糖尿病》实践指南标志着一个新时代的开始，此后发布了多项指南，帮助全科医生在临床实践中运用循证医学；这些指南也有助于教学。该指南的第二次修订有许多改进之处，尤其是在用药方案方面进行了简化。然而，使用噻唑烷二酮类药物的新建议仅基于一项大型研究，且存在一些不实用的方面。新指南未提及预防措施，也未给出早期检测的建议。近年来，随着糖尿病专科护士的引入，临床实践发生了变化，尽管有关于这一主题的已发表研究，但指南并未对此给出任何建议。同样缺失的还有针对内科专科医生的国家临床指南。当患者按照全科医生的指南治疗无效并被转诊至内科专科医生处时，治疗方法各不相同，似乎依赖于医生。同样重要的是，那里的治疗也应标准化，以便全科医生能更有效地进行转诊。
