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Principles to guide type 2 diabetes care. Lancet. Online dokument 69 sidor.

The USA has the third highest burden of diabetes in the world. 29·1 million people (9·3% of the population) have the disorder, including 8·1 million who are undiagnosed. Of the US adults who have a confirmed diagnosis of diabetes, 90—95% have type 2 diabetes.
 
Reflecting this burden, several US societies, associations, and federal agencies provide advice and (sometimes conflicting) clinical practice guidelines for type 2 diabetes, which can be confusing for practitioners. Which should be followed?
 
A new resource from the National Diabetes Education Program—a partnership between the National Institutes of Health and the Centers for Disease Control and Prevention—aims to help.
 
Guiding Principles for the Care of People With or at Risk for Diabetes focuses on areas across the spectrum of care in which there is general agreement in existing guidelines. The ten guiding principles cover areas such as identification of people with undiagnosed diabetes and prediabetes, provision of self-management education, nutrition therapy, physical activity, control of blood glucose, and management of complications.
 
The final two principles can be seen as overarching ones. The first is to consider the needs of special populations, including children and high-risk racial and ethnic groups. Such a focus is needed in the USA in view of the growing rates of the disorder in children and the suboptimum care for diabetes that especially occurs in disproportionately affected poor or minority populations.
 
The final guiding principle—to provide patient-centred care, defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values”—is perhaps the most important. The document acknowledges that achieving this goal can be challenging; patient preferences might go against evidence-based guidelines, and discussion of pros and cons and patient goals requires time and effort. As a result, patient-centred care might be seen as worthy but too difficult. However, such an approach is crucial to diabetes; the foundations of treatment and prevention—self-management, improved nutrition, and increased physical activity—are much more likely to be achieved with it than without it.
 
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