Editorial illustrates shift away from glycemic control in diabetes treatment

February 20, 2014
This image shows the "lend a hand" illustration: an open palm facing out. The five major forms of diabetes interventions are arranged in descending order of importance from thumb to pinky. The order is smoking cessation, blood pressure control, metformin therapy, lipid reduction, and glucose control, respectively. Credit: Modified by Heather White, Tufts University

An editorial in a February issue of American Family Physician proposes a simple way for physicians to communicate with patients about the best treatments for diabetes. The "lending a hand" illustration reprioritizes treatment goals, based on research on mortality reduction, to convey that glycemic control is no longer the primary intervention.

In order of benefit, to improve length and quality of life, patients with type 2 benefit from these interventions, starting with :

"Glycemic control is stuck in people's minds as the primary goal of treatment, but evidence has existed since the 1970s that other interventions are of greater benefit," said senior author Allen Shaughnessy, Pharm.D., M.Med.Ed., professor of family medicine at Tufts University School of Medicine and fellowship director of the Tufts University Family Medicine Residency Program at Cambridge Health Alliance.

Shaughnessy and colleagues wrote the editorial on their "lending a hand" illustration to demonstrate the paradigm shift in treatment priorities. "Lending a hand" emphasizes interventions that improve length and quality of life for those living with type 2 diabetes, in line with new guidelines from the American Diabetes Association and the European Association for the Study of Diabetes.

The "lending a hand" illustration uses the fingers of an open hand to depict diabetes interventions from thumb to pinky in descending order of benefit, relative to complications and mortality. Smoking cessation is considered the most important intervention (the thumb). Blood pressure control, metformin drug therapy, and lipid reduction follow along the pointer to ring finger. Glycemic control, considered the least important intervention, is relegated to the pinky.

"Some degree of is necessary to prevent symptoms," Shaughnessy said. "It's just that the return on investment is low when we try to push patients with diabetes to get their blood glucose as close as possible to normal."

According to the National Diabetes Information Clearinghouse, approximately 25.8 million Americans have diabetes, and seven million of those may not be diagnosed. The NDIC further estimates that accounts for 90-95 percent of all cases of diabetes. Diabetes is a major cause of heart disease and stroke and the leading cause of new cases of blindness among adults.

"Our aim in proposing "lending a hand" is to communicate the most beneficial interventions patients can make to reduce their symptoms and risk of death from . But this model requires a shift in thinking away from the outdated idea that glucose reduction is most important, which may be a challenge," said first author Deborah Erlich, M.D., M.Med.Ed., assistant professor at TUSM, assistant family medicine clerkship director, and program director of the new Carney Family Medicine Residency, a TUSM affiliate.

"Working to control blood glucose while not addressing the other risk factors first is like rearranging deck chairs on the Titanic. The ship's going down," said author David Slawson, M.D., professor and vice chair of the department of family medicine, director of the Center for Information Mastery, and director of the fellowship at University of Virginia School of Medicine.

Explore further: Lifestyle changes cut diabetes risk in high-risk patients

More information: Erlich DR, Slawson DC, Shaughnessy AF. "'Lending a hand' to patients with type 2 diabetes: A simple way to communicate treatment goals." American Family Physician (89:4), 256-258. Feb. 15, 2014.

Related Stories

Lifestyle changes cut diabetes risk in high-risk patients

October 16, 2013
(HealthDay)—Comprehensive lifestyle interventions decrease the incidence of type 2 diabetes in high-risk patients, but the benefits are less clear in diagnosed patients, according to a review published in the Oct. 15 issue ...

Most patients at diabetes risk consider themselves healthy

January 24, 2014
(HealthDay)—Nearly 80 percent of patients at elevated risk for type 2 diabetes think they are in excellent or very good health, according to a new survey from the American Diabetes Association (ADA).

Exercise, diet and lifestyle changes can prevent diabetes in people at high risk

November 28, 2013
(Medical Xpress)—People at high risk of developing diabetes can prevent its onset if they exercise, improve their diet and make one other lifestyle change such as seeking counselling or quitting smoking, according to recently ...

Change in guidelines for Type 2 diabetes screening may lead to under-diagnosis in children

February 11, 2014
New American Diabetes Association (ADA) screening guidelines may lead to the missed diagnoses of type 2 diabetes in children, according to a new study by University of Michigan.

Nonsurgical treatment of periodontitis for persons with diabetes does not improve glycemic control

December 17, 2013
For persons with type 2 diabetes and chronic periodontitis, nonsurgical periodontal treatment did not result in improved glycemic control, according to a study appearing in the December 18 issue of JAMA.

Future directions for landmark diabetes study

January 28, 2014
The two most highly cited diabetes research trials – Diabetes Control and Complications Trial (DCCT) and its follow-up study Epidemiology of Diabetes Interventions and Complications (EDIC) – are marking their 30th anniversary. ...

Recommended for you

Scientists discover a new way to treat type 2 diabetes

July 21, 2017
Medication currently being used to treat obesity is also proving to have significant health benefits for patients with type 2 diabetes. A new study published today in Molecular Metabolism explains how this therapeutic benefit ...

Alzheimer's drug cuts hallmark inflammation related to metabolic syndrome by 25 percent

July 20, 2017
An existing Alzheimer's medication slashes inflammation and insulin resistance in patients with metabolic syndrome, a potential therapeutic intervention for a highly dangerous condition affecting 30 percent of adults in the ...

Diabetes or its precursor affects 100 million Americans

July 19, 2017
Almost one-third of the US population—100 million people—either has diabetes or its precursor condition, known as pre-diabetes, said a government report Tuesday.

One virus may protect against type 1 diabetes, others may increase risk

July 11, 2017
Doctors can't predict who will develop type 1 diabetes, a chronic autoimmune disease in which the immune system destroys the cells needed to control blood-sugar levels, requiring daily insulin injections and continual monitoring.

Diabetes complications are a risk factor for repeat hospitalizations, study shows

July 7, 2017
For patients with diabetes, one reason for hospitalization and unplanned hospital readmission is severe dysglycemia (uncontrolled hyperglycemia - high blood sugar, or hypoglycemia - low blood sugar), says new research published ...

Researchers identify promising target to protect bone in patients with diabetes

July 7, 2017
Utilizing metabolomics research techniques, NYU Dentistry researchers investigated the underlying biochemical activity and signaling within the bone marrow of hyperglycemic mice with hopes of reducing fracture risks of diabetics

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.