The aims and standards of care for people with diabetes have been set out in a number of different meetings and papers. Two of the most important publications are the St Vincent Declaration in 1989 and the National Service Framework (NSF) for Diabetes, which was published in 2001.

St Vincent Declaration¹

Diabetes mellitus in Europe: a problem at all ages in all countries

General goals for people - children and adults - with diabetes

• Sustained improvement in health experience and a life approaching normal expectation in quality and quantity.
• Prevention and cure of diabetes and of its complications by intensifying research effort.

Five-year targets

• Elaborate, initiate and evaluate comprehensive programmes for detection and control of diabetes and of its complications with self-care and community support as major components.
• Raise awareness in the population and among healthcare professionals of the present opportunities and the future needs for prevention of the complications of diabetes and of diabetes itself.
• Organise training and teaching in diabetes management and care for people of all ages with diabetes, for their families, friends and working associates and for the healthcare team.
• Ensure that care for children with diabetes is provided by individuals and teams specialised both in the management of diabetes and of children, and that families with a diabetic child get the necessary social, economic and emotional support.
• Reinforce existing centres of excellence in diabetes care, education and research. Create new centres where the need and potential exist.
• Promote independence, equity and self-sufficiency for all people with diabetes: children, adolescents, those in the working years of life and the elderly.
• Remove hindrances to the fullest possible integration of the diabetic citizen into society.

Implement effective measures for the prevention of costly complications:

• Reduce new blindness due to diabetes by one third or more.
• Reduce numbers of people entering end-stage diabetic renal failure by at least one third.
• Reduce by one half the rate of limb amputations for diabetic gangrene.
• Cut morbidity and mortality from coronary heart disease in the diabetic by vigorous programmes of risk factor reduction.
• Achieve pregnancy outcome in the diabetic woman that approximates that of the non-diabetic woman.
• Establish monitoring and control systems using state-of-the-art information technology for quality assurance of diabetes healthcare provision and for laboratory and technical procedures in diabetes diagnosis, treatment and self-management.
• Promote European and international collaboration in programmes of diabetes research and development through national, regional and WHO agencies and in active partnership with diabetes patients' organisations.
• Take urgent action in the spirit of the WHO programme, 'Health for All' to establish joint machinery between WHO and IDF, European Region, to initiate, accelerate and facilitate the implementation of these recommendations.

At the conclusion of the St. Vincent meeting, all those attending formally pledged themselves to strong and decisive action in seeking implementation of the recommendations on their return home.

The National Service Framework for Diabetes²

The 'National Service Framework for Diabetes: Standards', published in December 2001, set out a vision of diabetes services which:

• Leads to fewer people developing diabetes and better care for those who have it.
• Is centred around the needs of people with diabetes, developed in partnership with healthcare staff, equitable, integrated and focused on delivering the best outcomes for the person with diabetes
• Offers care that is structured and proactive, providing people with the support they need to manage their own condition.

NSF standards

1. Prevention of type 2 Diabetes: the NHS will develop, implement and monitor strategies to reduce the risk of developing type 2 diabetes in the population as a whole and to reduce the inequalities in the risk of developing type 2 diabetes.
2. Identification of people with diabetes: the NHS will develop, implement and monitor strategies to identify people who do not know they have diabetes.
3. Empowering people with diabetes: all children, young people and adults with diabetes will receive a service which encourages partnership in decision-making, supports them in managing their diabetes and helps them to adopt and maintain a healthy lifestyle. This will be reflected in an agreed and shared care plan in an appropriate format and language. Where appropriate, parents and carers should be fully engaged in this process.
4. Clinical care of adults with diabetes: all adults with diabetes will receive high-quality care throughout their lifetime, including support to optimise the control of their blood glucose, blood pressure and other risk factors for developing the complications of diabetes.
5. Clinical care of children and young people with diabetes: all children and young people with diabetes will receive consistently high-quality care and they, with their families and others involved in their day-to-day care, will be supported to optimise the control of their blood glucose and their physical, psychological, intellectual, educational and social development.
6. All young people with diabetes will experience a smooth transition of care from paediatric diabetes services to adult diabetes services, whether hospital-based or community-based, either directly or via a young people's clinic. The transition will be organised in partnership with each individual and at an age appropriate to and agreed with them.
7. Management of diabetic emergencies: the NHS will develop, implement and monitor agreed protocols for rapid and effective treatment of diabetic emergencies by appropriately trained healthcare professionals. Protocols will include the management of acute complications and procedures to minimise the risk of recurrence.
8. Care of people with diabetes during admission to hospital: all children, young people and adults with diabetes, admitted to hospital, for whatever reason, will receive effective care of their diabetes. Wherever possible, they will continue to be involved in decisions concerning the management of their diabetes.
9. Diabetes and pregnancy: the NHS will develop, implement and monitor policies that seek to empower and support women with pre-existing diabetes and those who develop diabetes during pregnancy, to optimise the outcomes of their pregnancy.
10. Detection and management of long-term complications: all young people and adults with diabetes will receive regular surveillance for the long-term complications of diabetes.
11. The NHS will develop, implement and monitor agreed protocols and systems of care to ensure that all people who develop long-term complications of diabetes receive timely, appropriate and effective investigation and treatment to reduce their risk of disability and premature death.
12. All people with diabetes requiring multi-agency support will receive integrated health and social care.

Document references

1. St Vincent Declaration. A Model for Prevention and Self Care; Saint Vincent (ITALY), 10-12 October 1989 (A meeting organised by the World Health Organization and the International Diabetes Federation in Europe)
2. National service framework for diabetes: standards, Dept of Health, 2001

Internet and further reading

• Care recommendations - The provision of services in primary care, Diabetes UK
• Diabetes guidelines, NICE; various dates

Acknowledgements