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The 2015 Standards for Diabetes Care: Maintaining a Patient-Centered ApproachThe 2015 Standards for Diabetes Care

Giulio R. Romeo, MD; and Martin J. Abrahamson, MD
[+] Article, Author, and Disclosure Information

This article was published online first at www.annals.org on 24 March 2015.

From Joslin Diabetes Center, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts.

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0385.

Requests for Single Reprints: Martin J. Abrahamson, MD, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215; e-mail, martin.abrahamson@joslin.harvard.edu.

Current Author Addresses: Drs. Romeo and Abrahamson: Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215.

Author Contributions: Conception and design: G.R. Romeo, M.J. Abrahamson.

Analysis and interpretation of the data: G.R. Romeo.

Drafting of the article: G.R. Romeo, M.J. Abrahamson.

Critical revision of the article for important intellectual content: G.R. Romeo, M.J. Abrahamson.

Final approval of the article: G.R. Romeo, M.J. Abrahamson.

Collection and assembly of data: G.R. Romeo.

Ann Intern Med. 2015;162(11):785-786. doi:10.7326/M15-0385
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This commentary highlights 3 topics in the American Diabetes Association's Standards of Medical Care in Diabetes that are relevant to nonendocrinologists who care for patients with diabetes: ethnic differences in diabetes risk with different body mass indices, blood pressure targets, and individualization of diabetes treatment goals.

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Do not treat diabetes but treat a patient with diabetes
Posted on March 31, 2015
Gauranga Dhar
Bangladesh Institute of Family Medicine and Research
Conflict of Interest: None Declared
Hyperglycemia management in patient with diabetes always should be patient-centered or in other words, individualized. Not only management but patient centered approach should be started even during screening and applicable to diagnostic thresholds as well. Antihyperglycemic agents as add on to metformin also should be decided individually. It is already well established that glycemic target should be done on basis of age, duration of diabetes, associated comorbidities.
There is a big controversy on the blood pressure target in diabetic patients in JNC-8 but my practical experience shows that microalbuminuria is significantly reduced if systolic blood pressure target can be reduced from <140mmHg to <125mmHg in diabetic population.
Great revolution in the area of statin use. We have no more LDL-C target but statin should be started to all diabetic patients above 40 years of age irrespective of baseline LDL-C and should be continued indefinitely unless contraindicated. Doses should be decided according to ASCVD risk.
After all, a physician should not manage diabetes but manage a patient with diabetes and the management option should be individual and patient-centered on the basis of recent guidelines.
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