Using multiple measures of glycemia to support individualized diabetes management: recommendations for clinicians, patients, and payers.
Diabetes Technol Ther
; 14(11): 973-83; quiz 983, 2012 Nov.
Article
em En
| MEDLINE
| ID: mdl-23066850
ABSTRACT
By the year 2030, the diabetes pandemic will likely affect more than 10% of the world's population. The personal, public health, and economic crises implicit in this trend call for decisive action. Yet, escalating dilemmas thwart full realization of current therapies. First, controversial studies, such as the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial, have amplified calls to individualize glycated hemoglobin (A1C) targets in the absence of adequate infrastructures for supporting personalized care. Second, costlier medications and technologies addressing more nuanced aspects of metabolic dysfunction are expanding options for diabetes management amidst growing disparities between "affordable" and "best" care. Third, common clinical quandaries, such as discrepancies between A1C and self-monitoring of blood glucose data, as well as misconceptions about long-term glycemic assessment, compound entrenched cycles of inadequate self-care, delayed intervention, and suboptimal glycemic outcomes. Because individual, clinical, and public policy responses to these conflicting forces are based largely on methodologies for glucose measurement, a panel of clinical experts from Europe and North America was convened to reexamine our glucose measuring tools and determine ways in which they can be better applied toward more purposeful processes of glycemic management. Among the main issues addressed were the need for caution in interpreting A1C for individual patients, the role of alternative biomarkers in identifying aspects of glycemic dysregulation not captured by A1C, and the value of using patients' own glucose data to consolidate therapeutic, educational, and behavior-change objectives.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Glicemia
/
Hemoglobinas Glicadas
/
Frutosamina
/
Diabetes Mellitus Tipo 1
/
Diabetes Mellitus Tipo 2
/
Medicina de Precisão
/
Hiperglicemia
/
Hipoglicemia
Tipo de estudo:
Etiology_studies
/
Guideline
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
País/Região como assunto:
America do norte
/
Europa
Idioma:
En
Revista:
Diabetes Technol Ther
Assunto da revista:
ENDOCRINOLOGIA
/
TERAPEUTICA
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
Estados Unidos