The Asian-Pacific region continues to be at the forefront of the type 2diabetes mellitus epidemic, with consequences to health which threaten tobe devastating. Younger members of our communities are not spared fromthis disease, with a significant problem emerging in the urbanised young inmore affluent parts of the region. Lifestyle changes and urbanisation appearto be the underlying causes of this problem, and continue to accelerate inthis new millennium.

 

     There is now overwhelming evidence of the need for optimal glycaemiccontrol of type 2 diabetes if the impact of long-term microvascularcomplications is to be minimised. The UK Prospective Diabetes Survey hasalso highlighted the importance of both very good glycaemic control andgood blood pressure control. This has been shown to be most relevant inthe prevention of stroke and is, therefore, particularly important in thisregion where stroke is a significant cause of diabetes-related mortality.

 

     Since publication of the third edition of Type 2 Diabetes Practical Targetsand Treatments, new evidence has emerged relating to the prevention ofboth diabetes and its complications, as well as new International DiabetesFederation (IDF) reports on key issues in diabetes, including obesity, kidneydisease and the metabolic syndrome. This fourth edition produced by theAsian-Pacific Type 2 Diabetes Policy Group is, therefore, timely. It providesan opportunity to update and revise those areas covered in the previousthree editions, and to add new information in other areas, particularly withregard to the role of exercise, management of type 2 diabetes in childrenand adolescents, and management of other cardiovascular risk factors andthe metabolic syndrome.

 

      These guidelines have the support of the IDF, Western Pacific Region, andhave been produced specifically with the needs of our region in mind.It should be emphasised that they are meant to complement rather thanreplace individual or national guidelines, to add the authority that can beprovided by a regional approach as an additional support for nationalguidelines, and also to provide guidelines for those countries that do nothave their own.

 

      We recommend this booklet to you and sincerely hope that it will beused widely by a variety of healthcare professionals in all countries withinthe region.

 

The Western Pacific Declaration on Diabetes 1

Foreword 2

Contents 3

Preface 4

IDF–WPR Chairman’s Statement 6

Asian-Pacific Type 2 Diabetes Policy Group 7

Chairmen’s Statement 8

Introduction

The Price of Social Change 10

Guide to the  Classification of Diabetes

Diagnosis Based on Venous Plasma 12

Type 1 or Type 2? 13

Type 2 Diabetes in Childhood and Adolescence 14

Management

Essentials of Management 16

Monitoring of Glycaemic Control 18

Food Planning 20

Physical Activity 22

Treatment

Pharmacological Treatment of Hyperglycaemia 24

Obese/Non-Obese

Selection (Phenotyping) for Appropriate Oral Hypoglycaemic Therapy 27

The Overweight or Obese Person with Diabetes 27

The Non-Obese Person with Diabetes 28

Special Situations

Special Situations 29

Hypoglycaemia

Hypoglycaemia 34

Chronic Complications

Retinopathy and Blindness 36

Nephropathy 37

Diabetic Foot Problems 38

Macrovascular Comorbidities, 40

Dislipidaemia and Hypertension 

The Metabolic Syndrome

The Metabolic Syndrome 43

Targets

Targets for Control 45

Prevention of Type 2 Diabetes

Lifestyle and Pharmacological Approaches 46

Protocols

Initial Visits 48

Clinical Monitoring Protocol 49

Appendices 50