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New evidence improves care

Blood glucose levels need to be more stringently controlled

Blood glucose levels should be more stringently controlled and patient education should be accessible and delivered by a multidisciplinary team, according to new type 2 diabetes treatment guidelines.

Rural and remote health practitioners are being updated on the new guidelines that match recommended patient treatment with the latest evidence and research, through a series of four programs currently being satellite broadcasted by the Rural Health and Education Foundation.
The initial program focused on Blood Glucose Control and Patient Education.

Stephen Colagiuri, diabetes expert and professor of metabolic health at the Institute of Obesity, Nutrition and Exercise at the University of Sydney, says since the first guidelines were introduced in 1999, more evidence has emerged.

“This evidence will improve the way in which patients can be treated – leading to a more customised approach which has been incorporated into these new guidelines,” says Colagiuri.

“In relation to the critical element of blood glucose control, not only have there been considerable advances in type 2 diabetes medications but numerous studies have also shown that if those levels are more stringently controlled, it can significantly reduce the risk of both microvascular and macrovascular complications.”

If type 2 diabetes patients can be made aware of this information through their health practitioner as part of their treatment, they will be better equipped to manage their condition.

There is now a more comprehensive range of specialist services which can be accessed by people, including those in regional areas, says Colagiuri.

“There are some vital services now available through Medicare that will form a valuable part of both initial and ongoing patient education on type 2 diabetes,” he says.

“It is also evident that patient education should be delivered, where possible, by a multidisciplinary team and should include a component on physical activity as well as encouragement for patients to participate in goal setting and decision making.”

The second program deals with the guidelines for patients who have developed chronic kidney disease and diabetic retinopathy.

The guidelines suggest that by knowing the general targets in care, addressing diabetes complications, individualised targets for blood glucose, blood pressure and cholesterol can then be customised – in consultation with a particular person who has diabetes.

Associate Professor Stephen Twigg, medical head of Endocrinology Research Laboratories at the Royal Prince Alfred Hospital in Sydney, says lifestyle still remains the key determinant in helping prevent the development of type 2 diabetes.

However, in patients who already have diabetic retinopathy and chronic kidney disease the new guidelines will assist in individualising appropriate targets from the general range and monitoring those targets which, with the added benefit of medication, can “empower people with diabetes to better manage their condition”.

Twigg says blood glucose is most closely linked to diabetic retinopathy and both blood glucose and blood pressure control are important targets in managing diabetic retinopathy and chronic kidney disease.

All people with diabetes are at risk of developing diabetic retinopathy at any point in time but vision loss or blindness is preventable through early detection and timely treatment. In Australia, diabetes is the most common cause of blindness in people under the age of 60.

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