BACKGROUND: Clinical guidelines form one of the cornerstones for providing 
high-quality care for patients with diabetes. We compare the national guidelines 
and the use of glucose lowering medication for type 2 diabetes (T2D) in Denmark, 
Finland, Norway and Sweden.
METHODS: We compared how guidelines take comprehensive care into consideration, 
what treatment targets and what antihyperglycemic medication was recommended. 
The use of glucose-lowering medication was based on the sales of diabetes drugs 
in these countries.
RESULTS: All guidelines stress the importance of comprehensive diabetes care. 
Individualized glycemic targets are emphasized especially in the Danish and 
Finnish guidelines. In 2013, sulfonylureas were the most common second-line 
treatment after metformin in Denmark, Norway and Sweden; in Finland, this 
position was taken by DPP-4 inhibitors. Recommended initial insulin type for 
patients with T2D differs between the four countries. Danish, Norwegian and 
Swedish guidelines also take economic aspects into account.
CONCLUSIONS: All guidelines stress regular and comprehensive diabetes care. 
Danish and Finnish guidelines strongly underline the importance of 
individualized glycemic targets. All guidelines recommend metformin as the 
initial oral antihyperglycemic drug. In relation to recommended second line drug 
therapy and initial insulin type for patients with T2D, the guidelines vary 
largely between the four countries.