DMP for diabetes type 2: Current guidelines indicate some need for revision

January 3, 2012

On 3 January 2012, the German Institute for Quality and Efficiency in Health Care (IQWiG) published the results of a literature search for evidence-based clinical practice guidelines on the treatment of people with diabetes mellitus type 2. The aim of the report is to identify those recommendations from current guidelines of high methodological quality that may be relevant for the planned revision of the corresponding disease management programme (DMP). According to the results of the report, there is no compelling need for revision of any part of the DMP. However, IQWiG identified various aspects that could be supplemented and specified.

Evidence was documented in detail

One of the responsibilities of IQWiG specified by law (Social Code Book V) is to develop and issue for DMPs. In the commission now completed, which was awarded by the Federal Joint Committee (G-BA), IQWiG systematically searched for new guidelines, assessed their methodological quality, and extracted relevant recommendations on the diagnosis and treatment of 2, its accompanying diseases and late complications, as well as on the cooperation of health care sectors. In addition, the Institute documented how highly the guideline authors graded the robustness of the recommendations. However, the sources of the recommendations were not examined again; this is where IQWiG's guideline appraisals and benefit assessments differ.

No contradictions between the DMP and current recommendations

A total of 35 German and international guidelines containing recommendations on the treatment of were included. As the analysis showed, the recommendations are, by and large, consistent with the specifications of the DMP. No contradictions in content concerning the DMP requirements were found. The Director of IQWiG, Professor Dr med. Jürgen Windeler, stresses that "patients with mellitus type 2 can thus be sure that the current DMP is consistent with the current status of medical knowledge on all main points."

Some potential additional recommendations identified for the DMP

However, in these guidelines, recommendations were found on a total of 8 subject areas where, after examination and discussion, the need was identified to update and supplement the German DMP for diabetes mellitus type 2, or at least to discuss such measures.

For example, some guidelines recommend additional medication. Among other things, this applies to the topical use of isosorbide dinitrate and capsaicin spray for treatment of painful diabetic neuropathy. For the prevention and treatment of diabetic foot syndrome, recommend examining the condition of the blood vessels by means of the ankle-arm index.

It is first of all the Institute's responsibility to identify differences between guideline recommendations and the DMP. The Federal Joint Committee then examines whether these differences should actually lead to a revision of the DMP for diabetes mellitus type 2.

Explore further: Guidelines on rare diseases: Methods on handling evidence neither identified nor required

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not rated yet Jan 05, 2012

It is interesting that not even a German scientific committee seems to be able to read the pre 1977 German scientific literature. Especially as the German speaking and writing European nutrition specialists were doing much of the now forgotten pre World War II research.
Remember the advice in 1921 how to cure patients with diabetes? Most of them had what we now call a DM1 but many of those early cases of DM1 survived and lived well on a low carbohydrate diet.
There are tens of thousands patients with DM2 in Sweden that benefit from a low carbohydrate diet enjoying much less medication, many of them are even free from all drugs after the diet change, contrary to the advice from their doctors. Its a paradigm shift going on in Sweden when the population realizes that they have seen the elephant in the room but the authorities still dont see the elephant.

The population now knows that the fat is good for us but excess carbohydrates are toxic to humans.
not rated yet Jan 05, 2012
I have now read the original report

and found that they have done an SBU (1) by limiting the timeframe between 2005 and up to March/April 2011.

SBU made a similar survey with a slightly larger timeframe The literature search covers the period from 1980 through September 2009

They found that the scientific evidence for the present diet recommendations was very fragile but as there are no alternative diets so we have to keep the present diet recommendations

Of course neither SBU nor IQWiG can find any old and honest research from the beginning of the 20th century when they limit the research timeframe.

This study is as bad as the SBU study by not revealing the whole and scientifically true story about toxic carbs

1. SBU Swedish Council on Health Technology Assessment

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