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There is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those with diabetes.

Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefit. Reasons include the size and complexity of the evidence-base, and the complexity of diabetes care itself. One result is a lack of proven cost-effective resources for diabetes care. Another result is diversity of standards of clinical practice.

Guidelines are one part of a process which seeks to address those problems. Many guidelines have appeared internationally, nationally, and more locally in recent years, but most of these have not used the rigorous new guideline methodologies for identification and analysis of the evidence.

Many countries around the world do not have the resources, either in expertise or financially, that are needed to develop diabetes guidelines. Also such a repetitive approach would be enormously inefficient and costly. Published national guidelines come from relatively resource-rich countries, and may be of limited practical use in less well resourced countries.

In 2005 the first IDF Global Guideline for type 2 diabetes was developed. This presented a unique challenge as we tried to develop a guideline that is sensitive to resource and cost-effectiveness issues. Many national guidelines address one group of people with diabetes in the context of one health-care system, with one level of national and health-care resources. This is not true in the global context where, although every health-care system seems to be short of resources, the funding and expertise available for health-care vary widely between countries and even between localities.

Despite the challenges, we feel that we found an approach which is at least partially successful in addressing this issue which we termed ‘Levels of care’(see next page).

This guideline represents an update of the first guideline and extends the evidence base by including new studies and treatments which have emerged since the original guideline was produced in 2005.