June 11, 2012
New Hyperglycemia Management Guidelines
After doing much reading and trying to follow what is said in the document released April 19, 2012 as the new hyperglycemia management guidelines, I am beginning to understand what is being said. The guidelines were published in DiabetesCare by the American Diabetes Association (ADA) and in Diabetologia by the European Association for the Study of Diabetes (EASD).
The last guidelines on management of hyperglycemia were published about five years ago and recent developments have now been incorporated into the new guidelines. The claim is made that there is growing complexity and some controversy in contemporary glycemic management for persons with type 2 diabetes – you think? What I do not understand is the thinking that oral medication is the route to follow by adding medication after medication to solve the problem.
According the experts, the answer has to follow the ACCORD rules and this is what pulled the study down. Medication on top of medication just does not work, but our diabetes experts think this is the only way and Big Pharma has them convinced that this is the route to go. This violates other statements and basically means things will be business as usual.
Oh, yes, the guidelines are full of platitudes to make us think that the new guidelines are patient oriented, but when the president of ADA's medicine and science states that the ADA set the HbA1c goal at 7% in general, but with some individualization, this means little or no change. At least other bloggers are thinking that little will change and that doctors will continue to push oral medication after oral medication until it is too late for insulin to prevent complications.
When the president for medicine and science of the American Diabetes Association, Vivian Fonseca, MD, of Tulane University in New Orleans criticizes a study, you know that the ADA has something to protect in the new guidelines. This is one of medication combinations – in fact the medication combination promoted in the chart so highly prized by the ADA.
I agree with Tom Ross when he states. “ What's new in these guidelines, apparently, is the emphasis on figuring out which drug combination is right for different kinds of patients, on the basis of many different factors which can limit the efficacy or safety of particular drugs in particular individuals. I don't think this is the revolution in thinking about diabetes care that I would have liked to see.”
Everything about the new guidelines seems prefaced on getting patients on medications and as soon as possible. There seems no room for patients that want to manage diabetes with diet and exercise; and there are many doing just that and succeeding.
The other point that really upsets me – if they are really advocating individuals and allowing individual choices, why is insulin listed last? This is just a continuation of the mantra of making this the medication of last resort when complications have already made themselves known. I really need to wonder if people that desire to move to insulin will be allowed the choice, or will the doctors want to keep piling oral medications on and generating more and more severe side effects. The side effects of insulin are minor in comparison to some of the oral diabetes medications. What are these so-called experts thinking? They must be followers of the insulin myths.