Patients should be “at the heart” of clinical decisions on type 2 diabetes treatment, according to “pragmatic” new international guidance on diabetes.
The joint guideline was published yesterday by the European Association for the Study of Diabetes and the American Diabetes Association. It was launched at this year’s annual EASD meeting in Berlin.
The document is less prescriptive than previous guidance of its type, and advocates more patient involvement in choice of therapy and the setting of treatment goals.
The EASD and ADA said patient-centred care should be the “organising principal underlying” the treatment of long-term conditions.
EASD president Andrew Boulton, professor of medicine at Manchester University, added: “Given the uncertainties in terms of type and sequence of therapies, this approach is particularly appropriate in type 2 diabetes.”
It highlights that diet and exercise remain the foundation of treatment and metformin is the optimal first-line drug. But after metformin, there are limited data to guide treatment, it says.
The guideline highlights that “ultimately” patients make the final decisions on their lifestyle choices and, to some degree, the drug interventions they use.
Equally, the new guidance also calls for individualised goals. While general recommendations regarding glycaemic control focused in the past on an HbA1c target below 7%, the new guidance calls for a more “pragmatic viewpoint”.
It says the precise glycaemic target should take into account individual patient factors, including their attitude and expected treatment efforts, disease duration, life expectancy and other co-morbidities.
Professor Boulton said: “The overarching goal should be to reduce blood glucose concentrations safely to a range that will substantially minimise long-term complications, but, always keeping in mind the potential adversities with treatment burden, particularly in the elderly who are more often exposed to multiple drug treatments.”
The guidance is published online in the journal Diabetologia.