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Review
. 2023 Jul;14(7):1093-1110.
doi: 10.1007/s13300-023-01418-0. Epub 2023 May 18.

Guardians For Health: A Practical Approach to Improving Quality of Life and Longevity in People with Type 2 Diabetes

Naresh Kanumilli  1 , Javed Butler  2 , Konstantinos Makrilakis  3 , Lars Rydén  4 , Michael Vallis  5 , Christoph Wanner  6 , Shelley Zieroth  7 , Ahmad Alhussein  8 , Alice Cheng  9
Affiliations
Review

Guardians For Health: A Practical Approach to Improving Quality of Life and Longevity in People with Type 2 Diabetes

Naresh Kanumilli et al. Diabetes Ther. 2023 Jul.

Abstract

Type 2 diabetes is one of the fastest-growing health emergencies of the twenty-first century, in part due to its association with cardiovascular and renal disease. Successful implementation of evidence-based guidelines for the management of patients with diabetes and pre-diabetes has been shown to improve patient outcomes by controlling risk factors for cardiovascular and renal disease. Recommendations include the early introduction of lifestyle adjustments, supported by pharmacological tools. Despite the availability of regularly updated, evidence-based guidelines, guideline implementation in clinical practice is low. As a result, people living with type 2 diabetes are not consistently receiving ideal clinical care. Improving guideline adherence has the potential to improve quality of life and longevity in patients with type 2 diabetes. This article introduces Guardians For Health, a global initiative that aims to improve guideline adherence by simplifying patient management and encouraging patient participation in the implementation of guidelines for type 2 diabetes. Guardians For Health is supported by a global community of implementers, with tools to support decision-making and quality assurance. Through achieving better guideline adherence, Guardians For Health hopes to achieve its vision to "stop early mortality by reducing cardiovascular and kidney complications in people with type 2 diabetes".

Keywords: Cardiorenal risk reduction; Guardians For Health; Guideline implementation; Mortality; Quality of life; Type 2 diabetes.

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Conflict of interest statement

Naresh Kanumilli has received grants or contracts from AstraZeneca, Boehringer Ingelheim and Liva Health; has received consulting fees from AstraZeneca, Boehringer Ingelheim and Novo Nordisk; has received payment for lectures and presentations from Abbot, AstraZeneca, Boehringer Ingelheim, Lilly, Mylan, Novo Nordisk and Sanofi; has received support for conference attendance from AstraZeneca, Boehringer Ingelheim and Mylan; and has an unpaid leadership or fiduciary role in the Primary Care Diabetes society and the South Asian Health Foundation. Javed Butler has been a consultant to 3iveLabs, Abbott, American Regent, Applied Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardiac Dimensions, Cardior, CVRx, Edwards, Element Sciences, Faraday, FastBio, FIRE1, G3 Pharmaceuticals, Impulse Dynamics, Inventiva, Ionis, Janssen, Lexicon, LivaNova, Medtronics, Merck, Novo Nordisk, Otsuka, Pfizer, Roche, Sanofi, Sequana and Vifor. Konstantinos Makrilakis has received honoraria for congress speeches from AstraZeneca, Abbot Hellas, AEBE, Boehringer Ingelheim, Novo Nordisk Hellas, Pharmaserv-Lilly, Roche, Sanofi, Servier, Vianex/MSD and Winmedica; has received support for congress attendance from AstraZeneca, Boehringer Ingelheim, Novo Nordisk Hellas, Sanofi and Vianex/MSD; has participated on an advisory board affiliated with Abbot, AstraZeneca, Boehringer Ingelheim, Novo Nordisk Hellas and Sanofi; their institution has also received support for research activities from AstraZeneca, Abbot Hellas, AEBE, Boehringer Ingelheim, Novo Nordisk Hellas, Pharmaserv-Lilly, Roche, Sanofi, Servier, Vianex/MSD and Winmedica. Lars Rydén has received payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Bayer AG, Boehringer Ingelheim and Novo Nordisk. Michael Vallis has received investigator-driven research contracts from Abbot Diabetes Care, Bausch Health and Novo Nordisk; consulting fees from Abbot Diabetes Care, Bausch Health, Boehringer Ingelheim, Novo Nordisk, Roche Diabetes Care and Sanofi; has received payment for lectures, presentations or speakers bureaus from Abbot Diabetes Care, Bausch Health, Boehringer Ingelheim, Lifescan, Merck, Novo Nordisk, Roche Diabetes Care and Sanofi; has received support for congress attendance from Abbot Diabetes Care, Novo Nordisk and Roche Diabetes Care. Christoph Wanner has received honoraria for lectures from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim and Fresenius Medical Care; has received honoraria for their involvement with steering committees and for participation on an advisory board affiliated with AstraZeneca, Bayer, Boehringer Ingelheim, Gilead, GSK, MSD and Vifor. Shelley Zieroth has received research grant support, served on advisory boards for, or had speaker engagements with Abbott, Akcea, AstraZeneca, Amgen, Alnylam, Bayer, BMS, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, Novartis, Novo Nordisk, Otsuka, Pfizer, Roche, Servier and Vifor Pharma; serves on a clinical trial committee or as a national lead for studies sponsored by AstraZeneca, Bayer, Boehringer Ingelheim, Merck, Novartis and Pfizer. Ahmad Alhussein is a full-time employee of Boehringer Ingelheim. Alice Cheng has received consulting fees from Abbot, AstraZeneca, Bayer, Boehringer Ingelheim, Dexcom, Eisai, Eli Lilly, HLS Therapeutics, Insulet, Janssen, Novo Nordisk, Sanofi and Takeda; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Abbot, Amgen, AstraZeneca, Bausch, Bayer, Boehringer Ingelheim, Dexcom, Eli Lilly, GSK, HLS Therapeutics, Insulet, Janssen, Medtronic, Merck, Novo Nordisk, Pfizer and Sanofi; has participated on a clinical trial advisory board affiliated with Applied Therapeutics and Sanofi; and is the Immediate Past Chair of Diabetes Canada.

Figures

Fig. 1
Fig. 1
Structure of the Guardians For Health programme. Three pillars underpin the GFH approach and are essential for achieving the vision of the programme. In support of the mission statement, three essential actions are defined. GFH Guardians For Health, GUARD Guideline Application in Real Life Digital, HCP healthcare professional, T2D type 2 diabetes
Fig. 2
Fig. 2
Countries currently engaged with the Guardians For Health programme. Orange: GFH countries 2021; dark blue: GFH countries 2022; light blue: countries reporting to a regional office but not independently operating as a GFH country. GFH Guardians For Health
Fig. 3
Fig. 3
The Guardians For Health community will allow different levels of engagement with the programme. GFH Guardians For Health, KPI key performance indicator
Fig. 4
Fig. 4
Guardians For Health dashboard tracker. a Blank patient record. Patient data relating to prescribed classes of medication, cardiorenal comorbidities, risk factors and laboratory parameters are inputted here. Information ‘(i)’ buttons can be selected to provide definitions and to direct users to guideline recommendations about risk factor/parameter targets and assessment intervals. b Example reporting screen displaying aggregated cardiorenal risk management data. Information about the use of guideline-recommended therapies and the monitoring and management of risk factors is displayed. Drop-down menus allow cohorts to be filtered by the presence of different comorbidities and to compare between different quarters to assess progress in the provision of guideline-based care. ACEi angiotensin-converting enzyme inhibitor, ARB angiotensin receptor blocker, BMI body mass index, BP blood pressure, CKD chronic kidney disease, CVD cardiovascular disease, eGFR estimated glomerular filtration rate, GLP-1 RA glucagon-like peptide-1 receptor agonist, HbA1c haemoglobin A1c, HF heart failure, HFrEF heart failure with reduced ejection fraction, LDL-C low-density lipoprotein cholesterol, MRA mineralocorticoid receptor antagonist, NOAC new oral anticoagulant, PCSK9i proprotein convertase subtilisin/kexin type 9 inhibitor, SGLT2i sodium-glucose co-transporter-2 inhibitor, UACR urinary albumin-creatinine ratio
Fig. 5
Fig. 5
Readiness assessment as a framework for behavioural modification
See this image and copyright information in PMC

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