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Ideas and Opinions |7 August 2018

Guidelines Versus Guidelines: What's Best for the Patient?

Boris Draznin, MD, PhD; David M. Nathan, MD; Mary T. Korytkowski, MD; Marie E. McDonnell, MD; Sherita Hill Golden, MD, MHS; Mark H. Schutta, MD; William T. Cefalu, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published at Annals.org on 22 May 2018.
  • University of Colorado Anschutz Medical Campus, Aurora, Colorado (B.D.)
    Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (D.M.N.)
    University of Pittsburgh, Pittsburgh, Pennsylvania (M.T.K.)
    Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (M.E.M.)
    Johns Hopkins University School of Medicine, Baltimore, Maryland (S.H.G.)
    University of Pennsylvania, Philadelphia, Pennsylvania (M.H.S.)
    American Diabetes Association, Arlington, Virginia (W.T.C.)

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0939.

    Corresponding Author: Boris Draznin, MD, PhD, 12801 East 17th Avenue, Aurora, CO 80045; e-mail, Boris.Draznin@ucdenver.edu.

    Current Author Addresses: Dr. Draznin: 12801 East 17th Avenue, Aurora, CO 80045.

    Dr. Nathan: 50 Staniford Street, Suite 340, Boston, MA 02114.

    Dr. Korytkowski: 3601 Fifth Avenue, Falk Building, Room 560, Pittsburgh, PA 15213.

    Dr. McDonnell: 75 Francis Street, Boston, MA 02115.

    Dr. Hill Golden: 1830 East Monument Street, Room 9052, Baltimore, MD 21287.

    Dr. Schutta: 3400 Civic Center Boulevard, Suite 4-900W, Philadelphia, PA 19104.

    Dr. Cefalu: 2451 Crystal Drive, Suite 900, Arlington, VA 22202.

    Author Contributions: Conception and design: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

    Analysis and interpretation of the data: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

    Drafting of the article: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

    Critical revision for important intellectual content: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

    Final approval of the article: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

    Collection and assembly of data: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.

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FULL TEXT
Diabetes mellitus is a chronic disease that frequently leads to debilitating and life-threatening complications. Optimally managing type 2 diabetes entails avoiding acute metabolic complications and preventing long-term microvascular conditions (retinopathy, nephropathy) as well as neuropathic and macrovascular complications (cardiovascular and peripheral arterial disease) that reduce quality of life and longevity. Epidemiologic and landmark randomized clinical trials in both types of diabetes established the primacy of glycemia as a causal factor for microvascular complications (1, 2). The DCCT (Diabetes Control and Complications Trial) (1) and UKPDS (United Kingdom Prospective Diabetes Study) (2) in type 1 and type 2 diabetes, respectively, demonstrated the benefits of achieving a hemoglobin A1c (HbA1c) level of 7% among participants in the intensive versus standard treatment groups. These studies form the basis for most guidelines that recommend an HbA1c level below 7%, provided that this goal can be achieved safely (3). Modification of these glycemic targets is recommended for older adults with limited life expectancy and for persons at high risk for hypoglycemia or other untoward effects (3).
The recently published guideline from the American College of Physicians (ACP) (4), recommending an individualized approach to glycemic targets in older populations with a limited lifespan or multiple comorbid conditions, is in line with previously published guidelines from the American Diabetes Association and other organizations (3). However, as clinicians, we believe that other ACP recommendations, particularly those that advocate relaxation...
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Draznin B, Nathan DM, Korytkowski MT, McDonnell ME, Golden SH, Schutta MH, et al. Guidelines Versus Guidelines: What's Best for the Patient?. Ann Intern Med. [Epub ahead of print 22 May 2018]169:186–187. doi: 10.7326/M18-0939

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Published: Ann Intern Med. 2018;169(3):186-187.

DOI: 10.7326/M18-0939

Published at www.annals.org on 22 May 2018

©
2018 American College of Physicians
5 Citations

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