Bangladesh has been experiencing a significant surge in the number of diabetics. Although epidemic, there was no national guideline for diabetes management. However, the common clinical guideline in local context was crucial to guide physicians to deal with rapidly shifting paradigm of diabetes management and to ensure optimal care. Realising the issue, Endocrine Society of Bangladesh and Diabetic Association of Bangladesh with the support from Sanofi-aventis have formulated a guideline for Bangladesh recently.

The guideline has been reviewed by American Diabetes Association (ADA) and approved for implementation. This guideline will serve as a benchmark to assist physicians

of Bangladesh in providing a holistic clinical approach to manage diabetics.

Key components of Diabetes management

• Assess diabetes control measuring HbAlc test at every 3-6 months

• Measure weight, height and calculate Body Mass Index (BMI) at regular interval

• Measure total blood pressure at every visit

• Measure total cholesterol, TG, HDL and LDL at every 1-2 years if previously normal and at 3-6 months if previously abnormal level

• Examine feet regularly at every 6 months or more frequently if high risk foot or active foot problem

• Ensure comprehensive eye care during diagnosis of diabetes and at every year onwards

• Screen for kidney problem due to diabetes at every year

• Encourage healthy lifestyle with healthy food, physical activity and quit smoking Whom to screen for

Diabetes

• Persons over 40 years of age, less than 40 years with any of

the family risk factor

• Over-weight and obese individuals

• High waist circumference, male 90 cm and female 80 cm

• Person with family history

• History of diabetes in pregnancy, frequent pregnancy loss

• History of hyperlipidemia

(increase fat in blood), high blood pressure, heart diseases, who has high uric acid and some other disease conditions like PCOS, NAFLD

• Previous history of prediabetic state — a state that occurs when a person's blood glucose levels are higher than that of normal, but not high enough for a diagnosis of diabetes

Target for patients with Diabetes

The guideline also developed a stepwise management plan with diet, discipline and drug. Objectives and priorities of treatment must be tailored according to the individual’s clinical context. Aggressive treatment in the elderly and infants should be avoided, but optimum diabetic control is essential in pregnancy.