Tuesday, May 15, 2012

You are officially recognized as a full partner in your health care

Management of Hyperglycemia in Type 2 Diabetes: A Patient Centered Approach
Position statement of the American Diabetes Association and the European Association for the study of Diabetes
April 2012

I recommend that you read the full document available from the American Diabetes Association. I plan to review and comment on 2 to 3 pages a day.  These guidelines have done an excellent job of putting into words the activities that are occurring every day in physicians , diabetes educations and dietitians offices around the world .

 Page 1 summary     
 You are officially recognized as a full partner in your health care

People with Type 2 diabetes are at increased risk of heart disease
The introduction  points out " this document refers to glycemic control; yet this needs to be pursued within a multifactorial risk reduction framework".   Preventing heart disease requires aggressive management of multiple risk factors, Blood pressure, lipids , aspirin use and smoking cessation also.

Patient - centered approach
Patient-centered care is defined as an approach to " providing care that is respectful of and responsive to individual patients preferences , needs, and values and ensuring that patient values guide all clinical decisions."

" in a shared decision -making approach, clinicians and patients act as partners, mutually exchanging information and deliberating on option , in order to reach a consensus on the therapeutic course of action "

Page 2 summary
  younger people with shorter duration of diabetes who achieve  A1c targets of <6.5  without  significant hypoglycemia may have a lower risk of developing cardiovascular disease

This page reminds us of the reality of Type 2 diabetes being a leading cause of cardiovascular disorders , blindness , end- stage kidney failure , amputations , and hospitalizations.

They also review the hope and benefits of our current treatment by reviewing  four studies results :
 * UKPDS( UK prospective study )
      - results from reducing A1c from 7.9 to 7 ( treated with sulfonylurea or insulin )
            a signficant reduction in the risk for developing eye , nerve and kidney damage
            a non- signficant reduction  in risk for cardiovascu;ar disease
        -results from treatment with metformin :
             fewer patients experienced heart attacks and had an overall
         -10 year followup of the  intensive treatment group:
              A1c had increased slightly but all intensive treatment groups had a reduction in heart attacks  and
              overall mortality
  *  Three other studies  in 2008 ,ACCORD and VADT had treatment goals of A1c <6 and ADVANCE
       with treatment goals of A1c of <6.5. None of these studies showed any  significant reduction in
       cardiovascular risk in the treatment groups.

      They did demonstrate a significant increase in the risk of hypoglycemia in the treatment groups.

       The ACCORD study had a 22 % increase in total mortality in the patients in the intensive treatment
       group. ( goal A1c <6 ) The increased mortality in this group seem to occur in  older patients
       struggling to achieve an A1c of < 6 .
       There were suggestions that younger people with shorter duration of diabetes and without
       cardiovascular disease benefited  from the more intensive therapy.
   *   finally a meta-analysis of these trials suggest that for every 1 % decrease in A1c may be associated
        with a 15 % relative risk reduction in non fatal myocardial infarction, but without any benefits on
        stroke are all-cause mortality
     Tomorrow- Treatment decisions  

    Have Fun , Be Smart and become a full informed partner in your health care
    David Calder, MD                                                          

1 comment:

  1. This article is very informative. Preventing complications of diabetes through diet food and daily exercise would help patient's health.



Your comments and questions are appreciated. David Calder,MD