Sandeep Vijan, MD, MS; Timothy P. Hofer, MD, MS; Rodney A. Hayward, MD
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Vijan S., Hofer T., Hayward R.; Guidelines for Glycemic Control in Type 2 Diabetes. Ann Intern Med. 1998;128:872. doi: 10.7326/0003-4819-128-10-199805150-00016
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Published: Ann Intern Med. 1998;128(10):872.
The VHA guideline group has done an excellent job of reviewing the available evidence and condensing it into a flexible practice guideline that is usable by clinicians and researchers. Adoption and dissemination of the guideline have been mandated by the VHA; plans are being made to monitor patients with diabetes and provide clinicians with feedback on their care.
Although the guideline states that patient preferences should be considered when goals are being set for glycemic control, it also provides numeric goals (for example, “patients who are likely to live a few years might have a target hemoglobin A1c level of about 0.09” and “Many perhaps most, patients will have a target of about 0.08”). We would caution against letting these “treatment goals” metamorphose into “quality standards.” Our experience with an ongoing study suggests that for many patients, treatment characteristics, rather than outcomes, may be the dominant factor in preference for therapy across the ranges of benefits predicted by our Markov model. To the extent that specific glycemic goals become quality standards, patient autonomy may be jeopardized by concerns over provider and institutional accountability.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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