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TORONTO - The International Diabetes Federation has released three sets of guidelines for health providers aimed at improving patient care and stemming the growing worldwide incidence of the disease.

The clinical guidelines - dealing with pregnancy, diabetics' oral health and patient monitoring of blood sugar levels - were announced at the World Diabetes Congress in Montreal.

"The new data that was released at this meeting through the IDF atlas indicates that things are worse than we thought they were," said Dr. Stephen Colagiuri, chair of the IDF task force on clinical guidelines, noting that an estimated 285 million people around the world have diabetes, a figure that's predicted to soar to 435 million within 20 years.

"And unfortunately diabetes is responsible for four million deaths a year and this is at a cost globally of $376 billion," Colagiuri, a professor of metabolic health at the University of Sydney in Australia, told a teleconference from Montreal.

Health-care professionals must be equipped with the latest improvements and standards in diabetes care to tackle the spiralling epidemic, he said. Type 2 diabetes, also sometimes known as adult-onset diabetes, represents up to 95 per cent of all cases of the disease.

The IDF issued its first guidelines on pregnancy, which are intended to set a global standard for the care of gestational diabetes and for women who already have the condition and become pregnant, said Dr. Lois Jovanovic, who penned the recommendations.

"The reason the guidelines were necessary is because the prevalence of diabetes in pregnancy or hyperglycemia complicating pregnancy is now over 10 per cent worldwide, which extrapolates to the major medical complication today in pregnancy," said Jovanovic, CEO and chief scientific officer of Sansum Diabetes Research Institute in Santa Barbara, Calif.

"A lack of identification of diabetes or hyperglycemia (high blood sugar) during pregnancy produces myriads of complications to both the mother and the infant," she said. "The most dreaded complications include fetal malformations, fetal death and abnormal growth and development - both interuterine growth retardation and overgrowth."

"Both the conditions are associated with adult metabolic syndrome or frank diabetes."

The IDF also released new guidelines on proper oral hygiene and for encouraging diabetics with non-insulin-treated Type 2 diabetes to perform regular self-monitoring of blood glucose.

Diabetics need to be taught to properly care for their teeth and gums because poor oral hygiene is associated with gingivitis, which can progress to more severe infection and inflammation causing periodontal disease. Inflammation can decrease insulin sensitivity and potentially worsen blood-sugar control.

"This is definitely a neglected area in the routine care for people who have diabetes," said Dr. Massimo Massi-Benedetti, IDF vice-president and chair of the group's committee on oral health guidelines.

Although a link has yet to be proven through research, there are suggestions that diabetes "might facilitate the onset and the progression of periodontitis," he said.

"People with diabetes need to be strongly advised to strictly follow the already existing guidelines for oral health for the general population."