The International Diabetes Federation (IDF) Recommends Tighter Control Of Blood Glucose Levels After Meals In People With Diabetes

Main Category: Diabetes
Also Included In: Nutrition / Diet
Article Date: 24 Sep 2007 - 14:00 PDT

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IDF issued the new global guideline for diabetes care which includes the management of postmeal glucose.1 The guideline emphasizes that people with diabetes should have their blood glucose levels closely monitored after meals in order to optimize diabetes control and reduce the risk of complications, particularly cardiovascular disease.2 This new approach will assist clinicians and organizations in developing effective strategies for managing diabetes. The new evidence-based global guideline was unveiled at the meeting of the European Association for the Study of Diabetes (EASD) in Amsterdam.

The new guideline (available below for download) offers a series of recommendations identifying how diabetes care could be optimised. Topics addressed in the new guideline are postmeal hyperglycaemia, treatment strategies and regimens, self monitoring of blood glucose (SMBG), and non-pharmacologic and pharmacologic therapies.

"Diabetes is now recognized as one of the largest epidemics humanity has ever faced and a leading cause of death. It accounts for 3.8 million deaths per year, many of which are related to cardiovascular disease. This new advancement underscores the importance for people with diabetes and their healthcare providers to adopt all possible ways to better manage the disease," said Professor Stephen Colagiuri, Chair of the IDF Task Force on Clinical Guidelines.

Until recently, a key recommendation for good diabetes management was to lower fasting or premeal blood glucose levels; however, recent studies suggest a link between postmeal glucose control and improved outcomes in people with diabetes. Existing global guidelines do not include the management of postmeal glucose.

In people with normal glucose tolerance, blood glucose levels are automatically monitored and controlled by the body. After eating, the body releases enough insulin to keep the plasma glucose within a normal range that rarely rises above 7.8 mmol/l (140 mg/dl) and usually returns to premeal levels within two to three hours.

In people with impaired glucose tolerance or diabetes, their body has little or no automatic control of blood glucose levels. After eating, they often experience extended periods of elevated blood glucose levels. This is due to a number of factors, including insufficient insulin secretion, decreased sensitivity to insulin action, inability to suppress glucose output from the liver and deficiencies in other hormones related to digestion.

The new IDF Guideline recommends that people with diabetes try to keep postmeal blood glucose levels to less than 7.8 mmol/l (140 mg/dl) two hours following a meal. The two-hour time frame for measuring glucose conforms to guidelines published by most of the leading diabetes organizations and medical associations.

IDF advises SMBG because it is the most practical method for measuring postmeal glucose and it allows people with diabetes to obtain "real-time" information about their glucose levels. This information enables people with diabetes and their healthcare providers to make timely adjustments in their treatment regimens to achieve and maintain their blood glucose levels within target.

"IDF recommends that people with diabetes include physical activity, healthy eating and weight control in their daily regimen," said Professor Antonio Ceriello, Chair of the Guideline Writing Group. "These remain the cornerstone of effective diabetes management and not only reduce postmeal glucose levels, but also improve blood pressure and cholesterol levels". The guideline also includes information on a number of medications which specifically target postmeal glucose levels.

References:

1. Guideline for Management of Postmeal Glucose, International Diabetes Federation, 2007
2. Ceriello A, Postprandial Hyperglycemia and Diabetes Complications: Is it Time to Treat? Diabetes 2005; 54(1):1-7

The International Diabetes Federation (IDF) is an umbrella organization of 200 member associations in more than 160 countries, representing almost 250 million people with diabetes, their families, and their healthcare providers. The mission of the IDF is to promote diabetes care, prevention and a cure worldwide. Its main activities include education for people with diabetes and healthcare professionals, public awareness campaigns and the promotion and exchange of information. IDF is a non-governmental organization in official relations with WHO and associated to the United Nations' Public Department of Information. For more information, please go to http://www.idf.org.

The Guideline for Postmeal Glucose Management can be ordered from the IDF Shop and can be obtained from the IDF stand at the meeting of the European Association for the Study of Diabetes (EASD) in Amsterdam, the Netherlands.

Diabetes is a leading cause of death in most developed countries, and there is substantial evidence that it is reaching epidemic proportions in many developing and newly industrialized nations. The number of people with diabetes is expected to increase alarmingly in the coming decades. In 1985, an estimated 30 million people worldwide had diabetes; in 2006, a little over two decades later, the figure has risen to almost 250 million. By 2025, the figure is expected to rise to 380 million (Diabetes Atlas, 3rd edition, International Diabetes Federation, 2006). People with diabetes are at increased risk of premature death through the effect of diabetes on cardiovascular disease: some 50 per cent of them die of cardiovascular disease.

http://www.idf.org