title: Comparison of National/Regional Diabetes Guidelines for the Management of Blood Glucose Control in non-Western Countries.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Searches were conducted using Medline, Google, and health ministry and diabetes association websites.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Institute of Cellular Medicine, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK, philip.home@ncl.ac.uk.
authors: Philip
authors: P
authors: Home
authors: Jihad
authors: J
authors: Haddad
authors: Zafar Ahmed
authors: ZA
authors: Latif
authors: Pradana
authors: P
authors: Soewondo
authors: Youcef
authors: Y
authors: Benabbas
authors: Leon
authors: L
authors: Litwak
authors: Serdar
authors: S
authors: Guler
authors: Jian-Wen
authors: JW
authors: Chen
authors: Alexey
authors: A
authors: Zilov
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