Guiding Principles for the Care of People With or at Risk for Diabetes

Guiding Principles for the Care of People With or at Risk for Diabetes


DR. KIRKMAN: So there are a lot of diabetes guidelines out there and sometimes they compete in various ways. But I think what people forget is that many of the principles for taking care of diabetes – everyone agrees with. DR. FRADKIN: Our point here is really to try to build on the guidelines that other groups have developed and find the elements that are common across all the guidelines – the areas in which there’s general agreement. DR. KIRKMAN: Providing diabetes care is very difficult
for providers, particularly primary care providers. And for them, diabetes might just be one condition
that they’re dealing with in that particular patient visit, which can be very short. DR. FRADKIN: Guiding Principles are key principles
that guide care providers in preventing and managing diabetes and, predominantly in this
document, we’re focusing on type 2 diabetes. DR. KIRKMAN: Guiding Principles are not guidelines. This is not an attempt to produce yet another
guideline document. It’s really just kind of a harmonization of
what everyone agrees is good care for people with diabetes. DR. FRADKIN: We had very broad input in the development
of these Guiding Principles. We brought together representatives from the
major diabetes and endocrine professional societies; also representatives from the major
primary care societies: internal medicine, family practice, geriatrics. So we brought together perspectives both of
specialists and generalists – and it really helped to have both perspectives as we crafted
the fine-tuning, the wording of the document. DR. FRADKIN: We’ve learned a huge amount since
the last time we put out the Guiding Principles. So, for example, the Food and Drug Administration
required cardiovascular outcome trials for diabetes drugs and now we know that some drugs
to lower blood glucose actually have some cardiovascular benefits. So, information like that is included. DR. KIRKMAN: Another thing that’s different in
this update is that we really focus more on individualization of care, and this has been
something that’s been evolving for the last five to ten years, just that – it’s not one size
fits all in diabetes, and we have more and more evidence that different people have different
risk-benefit ratios in terms of treating diabetes. DR. FRADKIN: It’s really become increasingly evident
that shared decision-making in which the patient helps to identify the goals and also helps
to choose among the increasing array of options for prevention and treatment is much more
likely to lead to an effective strategy to control diabetes and prevent complications. So we’ve included a lot of emphasis on motivational
interviewing, shared decision-making, behavioral approaches, basically focusing on how to engage
patients, because the treatment of diabetes goes well beyond medication and the patient
is really the person who’s managing his or her own diabetes. DR. KIRKMAN: So in addition to the writing group
members who represented a number of different organizations, we also sent the draft Guiding
Principles out for review to a number of NDEP partner organizations. So I really want to thank those organizations
too, because in many cases they gave us really useful feedback and helped us make the document
even better.

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