Finnish Current Care Guideline for Diabetes: interactive approach to improve individualised treatment

Abstract

Keywords Algorithms.Clinical guidelines.Diabetesguidelines.GuidelinesAbbreviationFCCD Finnish Current Care Guideline for DiabetesTo the Editor: Dr R. Kahn recently wrote a Commentary inDiabetologia regarding the need to improve clinical guide-lines [1]. We would like to highlight some practical andreadily available ways of overcoming many of the problemsraised by Kahn in his excellent paper.The Finnish Current Care Guideline for diabetes (FCCD)[2] was published in 2007 and is authorised by the FinnishMedical Society Duodecim and the Finnish Society ofInternal Medicine. The guideline treats the timing of theclinical decision for intervention as the main priority.Several approaches have been used.Publication Only a browser-operated online version of theFCCD is available, which offers several benefits. Onlinepublication facilitates both the actual update process andenables a quick response to changes (e.g. withdrawal of adrug from the market). Most importantly, however, onlinepublication ensures that all healthcare professionals havethe latest version of the guideline at their disposal. Inaddition, it means that the guideline is readily available atthe physician’s office.As an electronic document, the table of contents in theFCCD is linked to the corresponding section of theguideline so that readers can quickly locate the subject ofinterest. Each statement in the text is hyperlinked to asummary of supporting evidence and is graded by the levelof evidence. The actual guideline is published in Finnish,but a summary is available in English [3].Interactivity and personalisation Kahn raised importantquestions regarding personalised treatment and targetsetting as, in general, guidelines deal poorly with theseissues. Guidelines on these were provided in the secondupdate of the FCCD in 2009, after results from the Actionto Control Cardiovascular Risk in Diabetes (ACCORD,[4]) study, the Veterans Affairs Diabetes Trial (VADT, [5])and Action in Diabetes and Vascular Disease: Preteraxand Diamicron Modified-Release Controlled Evaluation(ADVANCE, [6]) study were published. These studiesemphasised the need for individual goal setting andtreatment. The problem with most evidence-based guide-linesisthattheyonlydealwiththeaveragepatient,withoutrecognizing specific clinical features of the patient. In reallife, however, many patients do not fit these criteria, andguidelines for these all too many outliers are lacking. The