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Editorial: SEMDSA Guidelines for Type 2 Diabetes 2009
2009 Volume 14 No 1 JEMDSA
Although there is a lack of accurate information on the number of people living with diabetes in South Africa (estimates are of approximately 2 million), it poses a major challenge to our society. Diabetes is the seventh most common cause of death; it also accounts for the majority of non traumatic amputations, is a prominent contributor to end stage renal disease and blindness, and is present in many people with acute strokes and myocardial infarction.
Yet there is extensive evidence that a wide range of interventions can change this somewhat gloomy picture. It is well recognised that improved glycaemic control reduces the prevalence of microvascular and neuropathic complications. Improved blood pressure control reduces both microvascular and macrovascular events and lipid lowering too has a beneficial effect on cardiovascular disease outcomes. Furthermore, there is recent evidence of a legacy effect of glycaemic control on rates of myocardial infarction and all cause mortality. In the same vein, screening for complications of diabetes e.g. retinopathy or the “at risk” foot with timeous intervention substantially lowers the dreaded adverse outcomes of blindness and amputations.
We the health care providers, need to work with our colleagues and patients to ensure that the available evidence is translated into practice, such that people with diabetes are diagnosed earlier and that their short and long term outcome is improved. It is in this light, and on the background of the publication of large trials in patients with type 2 diabetes, that the SEMDSA 2009 Guideline has been developed. It replaces the first SEMDSA Clinical Practice Guideline for Type 2 diabetes published in 1997, which was a comprehensive document and the pocket-type SEMDSA Guideline in 2002/3.
The 2009 Guideline was developed by a group of experienced practitioners from both the public and private sector and had input from a broad range of SEMDSA members. DESSA, Diabetes South Africa and representatives from the Department of Health were all invited participants of the Guideline meeting. The Guideline which is based on the latest available evidence has been produced in two forms — a long version which is printed in this journal and an
abbreviated form which is suitable for use as a pocket reference guide. The 2009 Guideline shows numerous changes from the 2002/3 version, and provides recommendations on diagnostic cut points, targets for control, the processes of care, education, lifestyle and pharmacological (glucose lowering, blood pressure, lipids and antiplatelet) therapy.
It is hoped that practitioners will find this guideline of value, use it extensively and thus contribute to reducing the burden of diabetes in South Africa.
Naomi (Dinky) Levitt Chairperson SEMDSA
Correspondence to: Prof Dinky Levitt e-mail: [email protected]
