Recommendations for management of hyperglycemia in type 2 diabetes in the Arab Countries based on the consensus statement from the American Diabetes Association [ADA] and the European Association for the Study of Diabetes [EASD]

ABSTRACT

We would like to emphasize that stepwise interventions will help to achieve glycemic goals. Unfortunately there are barriers to effective management of hyperglycemia in type 2 diabetes, particularly in much of the Arab world [38]. We would like to emphasize that antihyperglycemic therapies with the possible exception of TZD should be titrated frequently [at intervals of days to at most weeks] based on glucose levels achieved and tolerability. Most patients can achieve A1C levels less than 7% in a matter of a few months. Suboptimal healthcare systems impede achievement of glycemic goals. Other barriers to effective management include insufficient communication with patients due to limited physician consultation time. This often contributes to inappropriate prescription of medications which patients cannot afford or will not tolerate and contributes to poor adherence. A multidisciplinary team approach to diabetes care - involving diabetologists, primary care providers, diabetes specialist nurses, pharmacists, dieticians and health educators, among others, with the patient at the centre of the team - has been demonstrated to improve both glycemic control and patient quality of life [39]. Equally or arguably more critical to optimizing patient outcomes is adequate treatment of comorbid conditions [e.g. dyslipidemia, hypertension, hypercoagulability] and early complications [e.g. retinopathy, microalbuminuria and the insensate foot]. A team approach with appropriate attention to patient education, motivation and adherence is critical to success, even if the team is just a patient and a primary care provider working together in a context of mutual respect with shared goals, understanding of their individual roles and open communication [40]. We strongly feel that these basic principles should guide every practitioner working with every patient with type 2 diabetes to ensure optimal care in their individual circumstance with an overall aim of reducing the proportion of patients who do not achieve control of diabetes with its asso-ciated omorbidities and complications from current levels of more than 60% [41,42]. Putting into consideration the local concerns mentioned above, our group supports the ADA/EASD consensus algorithm. Our aim is to highlight specific barriers in the Arab world and to adapt these recommendations to be more consistent with local circumstances in our countries