Institute of Cellular Medicine, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK,
Diabetes Ther. 2013 Jun;4(1):91-102. doi: 10.1007/s13300-013-0022-2. Epub 2013 May 4.
Development of higher standards for diabetes care is a core element of coping with the global diabetes epidemic. Diabetes guidelines are part of the approach to raising standards. The epidemic is greatest in countries with recent rises in income from a low base. The objective of the current study was to investigate the availability and nature of locally produced diabetes guidelines in such countries.
Searches were conducted using Medline, Google, and health ministry and diabetes association websites.
Guidelines were identified in 33 of 75 countries outside North America, western Europe, and Australasia. In 25 of these 33 countries, management strategies for type 1 diabetes were included. National guidelines relied heavily on pre-existing national and international guidelines, with reference to American Diabetes Association standards of medical care and/or other consensus statements by 55%, International Diabetes Federation by 36%, European Association for the Study of Diabetes by 12%, and American Association of Clinical Endocrinologists by 9%. The identified guidelines were generally evidence-based, though there was some use of secondary evidence reviews, including other guidelines, rather than original literature reviews and evidence synthesis. In type 1 diabetes guidelines, the option of different insulin regimens (mostly meal-time + basal or premix regimens) was recommended depending on patient need. Type 2 diabetes guidelines either recommended a glycosylated hemoglobin target of <7.0% (<53 mmol/mol) (70% of guidelines) or <6.5% (<47 mmol/mol) (30% of guidelines) as the ideal glycemic target. Most guidelines recommended a target fasting plasma glucose that fell within the range of 3.8-7.2 mmol/L. Most guidelines also set a 2-h post-prandial glucose target value within the range of 4.0-8.3 mmol/L.
While only a first step in achieving a high quality of disease management, national guidelines of quality and with fair consistency of recommendations are becoming prevalent globally. A further challenge is implementation of guidelines, by integration into local care processes.
提高糖尿病治疗标准是应对全球糖尿病流行的核心要素。糖尿病指南是提高标准的方法之一。收入水平从低基数上升的国家，糖尿病流行情况最为严重。本研究旨在调查这些国家是否制定了当地的糖尿病指南，以及指南的制定情况。
通过 Medline、Google 及卫生部和糖尿病协会网站进行检索。
在北美、西欧和澳大拉西亚以外的 75 个国家中，有 33 个国家制定了指南。在这 33 个国家中的 25 个国家中，纳入了 1 型糖尿病的管理策略。国家指南严重依赖于先前的国家和国际指南，55%的指南参考了美国糖尿病协会的医疗标准，或其他共识声明，36%的指南参考了国际糖尿病联盟，12%的指南参考了欧洲糖尿病研究协会，9%的指南参考了美国临床内分泌医师协会。所确定的指南通常是基于证据的，尽管有些指南使用了二级证据综述，包括其他指南，而不是原始文献综述和证据综合。在 1 型糖尿病指南中，根据患者的需要，建议选择不同的胰岛素方案（主要是餐时+基础或预混方案）。2 型糖尿病指南建议将糖化血红蛋白目标值设定为<7.0%（<53mmol/mol）（70%的指南）或<6.5%（<47mmol/mol）（30%的指南），作为理想的血糖目标。大多数指南建议空腹血糖目标值在 3.8-7.2mmol/L 范围内。大多数指南还设定了餐后 2 小时血糖目标值在 4.0-8.3mmol/L 范围内。
虽然这只是实现高质量疾病管理的第一步，但具有高质量和公平一致性建议的国家指南在全球范围内越来越普遍。进一步的挑战是将指南纳入当地护理流程，以实现指南的实施。
