New guidelines for treatment of Type 2 diabetes from International Diabetes Federation soon

New guidelines for treatment of Type 2 diabetes from International Diabetes Federation soon

Sub : Sci

Sec: Health

New IDF Guidelines for Type 2 Diabetes:

• The International Diabetes Federation (IDF) is preparing new global guidelines for managing Type 2 diabetes, which will be officially launched at the World Congress in Bangkok in April 2024.
• The guidelines are being developed by an expert panel led by Prof. Antonio Ceriello and IDF President Peter Schwarz, and are designed to address the unique needs of diverse populations worldwide.

Key Features of the New IDF Guidelines:

1. Patient-Centric Approach:
   • Focuses on tailoring diabetes care based on the local healthcare environment rather than relying solely on the availability of advanced medications.
   • Emphasizes putting the patient, not drugs, at the center of the care model.
2. Global Applicability:
   • The guidelines aim to be practical for use in both high-income and low-income countries, unlike existing guidelines from the American Diabetes Association (ADA) or the European Association for the Study of Diabetes (EASD), which may not consider affordability and accessibility issues globally.
3. Flexibility and Basic Care Standards:
   • Sets a minimum, basic level of diabetes care that should be a universal right, regardless of the economic status of a country.
   • Insulin remains the recommended first-line therapy, rather than newer, more expensive drugs like GLP-1 receptor agonists including semaglutide, which have limited availability and unproven long-term safety data.
4. Addressing Drug Affordability and Access Issues:
   • The guidelines caution against recommending costly drugs like GLP-1 receptor agonists as first-line treatments due to limited accessibility, affordability, and potential shortages.
   • Schwarz emphasized that transitioning patients from insulin, a cheaper option, to lifelong expensive treatments requires careful consideration of both financial and social impacts.
5. Integration of Evidence-Based Recommendations:
   • IDF guidelines incorporate the latest scientific evidence, focusing on practical, real-world applications tailored to specific countries.

Innovations and Future Directions:

1. Global Diabetes Index:
   • IDF is creating a Global Diabetes Index, collecting feedback from 100,000 physicians and patients annually to compare diabetes care quality across different regions. This will help identify and share best practices.
2. Emphasis on Digital Health:
   • Highlights the potential of Continuous Glucose Monitoring (CGM) and digital tools, including smartphone apps and artificial intelligence, for early diagnosis and personalized interventions.
3. Fasting and Diabetes:
   • IDF is studying various fasting models (including intermittent and religious fasting) to determine their effects on diabetes management, with recommendations expected in 1-2 years.
4. Focus on Prevention:
   • Advocates for early identification of risk factors, particularly liver fat, as a marker for diabetes, and the use of digital tools for preventive measures.

Regional Considerations:

• India’s Role:
  • India was chosen for a pre-launch of the guidelines due to its diverse diabetes population and openness to new approaches.
  • The guidelines incorporate inputs from countries like India to ensure they reflect varied healthcare settings, especially where out-of-pocket expenses are high.
• Ethnic and Demographic Variations:
  • The guidelines acknowledge differences in diabetes presentation globally (e.g., younger onset and lower BMI in Indian patients compared to Western populations).
  • Suggests different diagnostic parameters for obesity based on regional risk factors (e.g., BMI of 23+ considered overweight in South Asians).

Challenges and Outlook:

1. Long-Term Data Needs:
   • Experts, including Dr. V. Mohan, highlighted the lack of long-term safety data for newer drugs like GLP-1 agonists, advocating for established therapies with decades of use and evidence.
2. Quality of Life and Patient Burnout:
   • The IDF aims to prioritize patient well-being and quality of life in future care models, recognizing high rates of diabetes-related burnout.
3. Call for Policy Action:
   • The IDF urges governments and stakeholders to adopt preventive measures and invest in diabetes care, with an emphasis on long-term benefits rather than short-term savings.
4. Potential Game-Changers:
   • Technological advancements like CGM, insulin pumps, AI-driven interventions, and the possibility of islet cell transplantation offer promising future avenues for diabetes management.
5. World Diabetes Day 2024 Message:
   • The focus will be on enhancing patient quality of life, advocating for patient-centered care, and leveraging digital tools for better outcomes.