8 things to consider when individualising glycaemic goals

Type 1 diabetes

By Kate Marsh

27 Jan 2016

In recent years there has been a move towards adjusting glycaemic targets based on individual patient characteristics and comorbidities.

While clearly important, the downside to this is the lack of a “gold standard” and the likely variation in targets set by different clinicians based on their own experience and knowledge of current evidence.

Addressing this issue in a recent study researchers from Israel and Italy asked 244 worldwide opinion leading diabetologists to rank the factors they took into consideration when setting their patients’ glycaemic targets.

“Life expectancy” and “risk of hypoglycaemia from treatment” were considered to be the most important factors whereas “resources” and “disease duration” were ranked the lowest.

They then developed an algorithm that included eight factors that should be considered when determining an appropriate glycaemic target for an individual:

  1. Risk of hypoglycemia from treatment  (Low risk/Moderate risk/High risk)
  2. Life expectancy (Long/ Decreased /Short)
  3. Important comorbidities (None/ One/ Two or more)
  4. Macrovascular and advanced microvascular complications (None/ One/ Two or more)
  5. Cognitive function (Excellent/ Some decline/ Severe decline)
  6. Adherence and motivation (Excellent/ Moderate/ Reduced)
  7. Disease duration (Short (<5 years) Moderate (5–20 years) Long (>20 years))
  8. Resources and support system (Readily available/ Available with effort/ Limited)

The algorithm was a decision-making tool that could supplement clinical decision-making when considering a glycaemic target for the individual patient with diabetes, the researchers concluded in the study published in Diabetes Care.

 Commenting on the findings, Professor Peter Coleman, Director of Diabetes and Endocrinology at Royal Melbourne Hospital said that while diabetes experts weigh up these factors based on years of experience, less experienced clinicians were likely to find the algorithm useful.

“It will need to be easy to use and will require significant knowledge about the patient…these are all important givens,” he told the limbic.

The algorithm could be provided in an online calculator similar to the cardiovascular risk or fracture risk calculators, which are commonly used in endocrinology practice, he suggested.

“ Overall [the algorithm] provides important structure behind the decision making implicit in providing personalised targets.

Given the explosion in therapeutics available for type 2 diabetes, reaching targets has become much more realistic,” he said. 

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