April 18, 2011

New AACE Guidelines Emphasize Individualized Care

I know why many diabetes professional groups fear recommending that individuals strive to attain lower HbA1c's; however, I have to disagree with the way they do it. Here the American Association of Clinical Endocrinology (AACE) does recommend individualized care plans at least. They get very shy when it comes to recommending anything lower that an A1c of 6.5 for fear of hypoglycemic episodes. This is standard practice among the diabetes professionals.

The comprehensive individualized care plans for patients with Type 1 and Type 2 diabetes was developed by a panel of 23 leading diabetes experts. They wisely set the care plans to account for the patients' risk for complications, other chronic health conditions, and the psychological, social, and economic status. Because of that fact that they are concerned about the safety of people being able to achieve an A1c of 6.5 all recommendations emphasize taking into account a patients risk for development of severe hypoglycemia.

For once the recommendations do take into account the use of technologies such as insulin pumps, and continuous glucose monitoring. They they surprise me with adding the importance of other conditions that sometimes may not be obvious to the treating physicians – sleep and breathing disturbances and depression. These conditions have been neglected to the detriment of diabetes patients in the past.

Now if they will take this information and work to alleviate sleep disorders, sleep apnea, and minimize depression, this could work to make life a lot better for people with diabetes. Other factors missing from the guidelines is handling other illnesses such as the occasional cold, flu, and other common maladies.

The guidelines do stress hyperglycemia but also the associated cardiovascular risk factors. Also in the guidelines is the recommendation for comprehensive diabetes lifestyle management education at the time of diagnosis and to continue this throughout the time the person has diabetes. Other topics of the education is medical nutrition therapy, physical activity, not using tobacco, and importance of adequate sleep.

I applaud the latest guidelines as far as they go. It seems that individualized care plans should include other objectives. No provisions have been made for those of us desiring to attain lower A1c goals. So again the diabetes professionals are ignoring many patients that can and do work to attain A1c goals lower than 6.5. So it is still up to us to work independently of these medical professionals who have no desire to support us in achieving better health, avoiding complications, and in general doing better that others in our treatment of diabetes.

Why do I say we have to work independently? I am slowly discovering that the diabetes medical professionals are working to reduce the time spent with us, stopping continuing education for us, and just praising us and ushering us out of the office. This is a shame that the guidelines do not make provisions for those of us that wish to attain A1c's lower than 6.5.

Then our medical insurance companies take these results and are searching for ways to cut testing supplies, necessary related tests, and other procedures because we work to have better health. We must fight an uphill battle with no support from either group and chances that in the drive to curtail rising medical costs, we will be discriminated against and have necessary medical support withheld in the name of health care rationing. Just does not seem fair.

Read the two articles here and here.

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