New Diabetes Algorithm Geared to Primary Care

A new comprehensive diabetes mellitus (DM) management algorithm for primary care physicians, endocrinologists, and other health care professionals has been created to guide these professionals in the treatment of patients with prediabetes and type 2 DM.

Recommendations in the algorithm consider the whole patient, the spectrum of risks and complications for the patient, and evidence-based approaches to treatment, according to its publisher, the American Association of Clinical Endocrinologists (AACE).

The document provides suggestions for treatment prioritization and risk reduction strategies. It also addresses the following circumstances and conditions that often are precursors to or are concurrent with a type 2 DM diagnosis:

• Management of DM and coexisting diseases or disorders in the prediabetic phase of disease.

• A hierarchy of steps for the management of high blood sugar control using an approach that balances age and comorbidities while minimizing the adverse effects of hypoglycemia and weight gain.

• Complications-centric treatment of overweight or obese patients, as opposed to a body mass index–centric approach, including medical and surgical treatments for greater weight loss.

• Management of cardiovascular disease risk factors, hypertension, and hyperlipidemia in patients with prediabetes or type 2 DM.

Among the algorithm’s key recommendations is that a comprehensive care plan for persons with DM must now consider obesity management as an integral part of the overall treatment plan to effectively reduce morbidity, mortality, and disability in the majority of patients with type 2 DM who are obese.

The algorithm suggests a blood sugar goal of less than 6.5% as optimal for most patients with DM, if it can be achieved in a safe manner, but recommends that the target be individualized on the basis of numerous factors, such as age, comorbid conditions, duration of DM, risk of hypoglycemia, patient motivation and adherence, and life expectancy. Higher targets may be appropriate for some patients and may change for a given patient over time, it was noted.

Every FDA-approved class of medications for DM is included, and the choice of therapies on the basis of the patient’s initial A1c level are differentiated.

The algorithm is a definitive, point-of-care tool for clinicians engaged in the treatment of patients who are at risk for or have DM, the AACE stated.

Because there are not enough endocrinologists to care for all patients, the algorithm is essential to help clinicians who are charged with these patients’ care, the AACE noted.

The recommendations are published online and in the March/April 2013 issue of the AACE’s peer-reviewed scientific journal Endocrine Practice.