The Utah Diabetes Prevention and Control Program (DPCP) recognizes the importance of optimizing care for patients with diabetes. In promoting this objective, the DPCP organized a panel of interested health care professionals to develop the Utah Diabetes Practice Recommendations for Adults 2012 (UDPR). The recommendations are intended to foster current diabetes care practices, and to provide useful outlines to guide health care professionals in the screening, diagnosing, and appropriate management of people with diabetes. The materials in the UDPR build upon and complement national and regional diabetes protocols. Members of the UDPR Panel have identified decision points to assist clinicians in providing consistent and appropriate diabetes care for their patients.
This edition of the UDPR aims to draw attention not only to glycemic control, but to all the other factors that affect the health of your patient with diabetes. Hypertension control and lipid control are critical to the prevention of cardiovascular events and deaths, as well as renal and retinal disease. Randomized, controlled trials show that control of these three factors can reduce morbidity and mortality by 50% (Gaede et al., 2008).
Included in these recommendations are tools to support you in achieving safe glycemic control in your patients. Well-designed and effectively carried out studies such as the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) have demonstrated convincingly that blood glucose control significantly affects the development of complications in individuals with either type 1 or type 2 diabetes. A direct link between blood glucose levels and the risk of complications has been firmly established, despite the fact that other factors such as genetics also play a significant role.
Providers should encourage individuals with diabetes to aim for the lowest blood glucose levels that do not place them at undue risk for hypoglycemia. The studies also show that any improvement in glucose control has the effect of slowing both the development and progression of microvascular complications.
NOTE: Guidelines should be used as instruments to assist providers in clinical practice. The practice standards introduced in the UDPR are based on published literature (evidence) and clinical opinion (consensus).
The position statement achieved through these guidelines may need to be modified when new evidence becomes available. Providers following these guidelines should be aware of ongoing developments in the field, evaluate their merits based on the level of evidence, and incorporate these results into their practice using their best clinical judgment.
Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008; 358(6): 580-591.