Type II diabetes mellitus clinical guidelines at primary health care level. A SEMDSA Consensus Document, 1997, in association with DESSA, ADSA.

To develop effective education and management programmes for all aspects of diagnosis, treatment and prevention of complications of type II diabetes mellitus in the primary care setting.

The approach suggested is intended to be adaptable to both optimal and minimal health care settings and to individual patient differences both in the public and the private sectors.

Few long-term studies are currently available worldwide comparing patient outcome (In terms of macrovascular morbidity and overall mortality) with the various treatment regimens or the clinical and biochemical targets recommended. As complications cannot be totally prevented with our current state of knowledge and therapeutics, attention must still be focused on secondary and tertiary prevention to slow the progression of complications after they have been detected.

Working groups of diabetologists, epidemiologists, gynaecologists, primary care physicians, nurse specialist educators, dieticians, podiatrists and patient-interest organisations reviewed and discussed the current scientific knowledge and clinical recommendations as reflected by the latest overseas position and consensus statements on the subject. The format and spirit of the document are based on the 'Guidelines for the management of non-insulin-dependent diabetes in Africa, 1996' and adapted through local clinical experience to the needs and realities of our country at a primary health care level setting.

These include details on the provision of information for early detection, effective management and integration of clinical services for type II diabetes into a multidisciplinary chronic (non-communicable) diseases programme within the existing and evolving national health care system, emphasis on lifestyle modification, appropriate education and medication, the prevention and treatment of complications and timely referrals to a higher level of health care, and the concept of the patient charter of rights and responsibilities in the hope of achieving an optimal level of self-management within the constraints of the disease.

Relevant organisations involved in the education and care of people with diabetes were asked to select representatives to participate in the guidelines working group of the National Diabetes Advisory Board (SEMDSA). Draft documents on 12 topics were produced, amended and widely circulated for comments, criticisms, consensus and endorsement.

The consensus conference and the complication and publication of this document were supported by a generous educational grant from Servier Laboratories (SA).