Diabetes Care: A Patient-Centered Approach

Type 2 diabetes treatment and blood sugar control should be individualized for each patient

(RxWiki News) Type 2 diabetes is a complex disease. As such, treating the disease also has become complex. Now, new treatment guidelines are reflecting the need to personalize treatment for individual patients.

The American Diabetes Association (ADA), along with the European Association for the Study of Diabetes (EASD), have issued new guidelines calling for a patient-centered approach to treatment.

That is, blood sugar goals should be determined based on each patient's health status.

"Ask your doctor what blood sugar goal is best for you."

As more and more diabetes drugs have become available, blood sugar control has become more complicated, even controversial, according to the authors of the new guidelines. There are growing concerns among patients and doctors about the potential risk that these new drugs pose to the heart health of diabetes patients.

With these concerns in mind, the ADA and EASD decided to gather a group of experts to develop recommendations for controlling high blood sugar in people with type 2 diabetes.

The emphasis of the new guidelines is on creating a patient-centered approach to type 2 diabetes treatment.

"These recommendations should be considered within the context of the needs, preferences, and tolerances of each patient; individualization of treatment is the cornerstone of success," the authors write.

Blood sugar is often measured using hemoglobin A1C levels (HbA1C), a calculation of blood sugar over a three month period. Generally, people without diabetes have HbA1C levels under 5.6 percent.

Most patients with type 2 diabetes have been told to get their HbA1C below 7.0 percent. However, the new guidelines suggest that blood sugar goals should be stricter for some and more lax for others.

In recent years, studies have been released showing both the benefits and risks of drugs used to lower blood sugar. Among these risks are deadly heart problems and dangerously low blood sugar (hypoglycemia).

The new guidelines suggest a target HbA1C between 6.0 and 6.5 percent for patients with a long life expectancy, no history of heart disease, and no history of hypoglycemia.

Similarly, they recommend less strict goals for higher risk patients, such as those with a history of hypoglycemia, a shorter life expectancy, or a history of heart disease. For these patients, the guidelines suggest an HbA1C target of 7.5 to 8.0 percent, "or even slightly higher."

As diabetes patients are told time and again, lifestyle changes are key to controlling blood sugar. The new guidelines make a point of this.

Losing about five to 10 percent of body weight has a meaningful effect on blood sugar control.

"Accordingly," the authors write, "establishing a goal of weight reduction, or at least weight maintenance, is recommended."

These new guidelines were written by a team of experts that included Silvio E. Inzucchi, M.D., of Yale University School of Medicine; Richard M. Bergenstal, M.D., of the International Diabetes Center in Minneapolis; John B. Buse, M.D., Ph.D., of the University of North Carolina School of Medicine; Michaela Diamant, M.D., Ph.D., of VU University Medical Center in Amsterdam; Ele Ferrannini, M.D., of the University of Pisa School of Medicine in Pisa, Italy; Michael Nauck, M.D., of Diabeteszentrum

Bad Lauterberg in Germany; Anne L. Peters, M.D., of the University of Southern California's Keck School of Medicine; Apostolos Tsapas, M.D., Ph.D., of Aristotle University Thessaloniki in Greece; Richard Wender, M.D., of Jefferson Medical College; and David R. Matthews, M.D., D.Phil., of the Oxford Centre for Diabetes, Endocrinology, and Metabolism.

The authors have disclosed any conflict of interest in the guidelines, which appear online before their coming publication in the journal Diabetes Care

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Review Date: 
April 23, 2012