July 19, 2013

New AACE Diabetes Algorithm Consensus Statement

Well, finally the criticism has forced the American Association of Clinical Endocrinologists (AACE) into action. They have now issued a new type 2 diabetes algorithms consensus statement to accompany the original algorithms. This consensus statement is 48 pages in length and is available for free download. Yes, again, it is in the PDF format and the original 8 pages of the diabetes algorithms are turned on their side to make them more difficult to read.

Now I must ask, did the criticism finally bring them to their senses? It may have, plus the blogger gnats may have become pesky enough. I think that Dr. Anne Peters and
Dr. Jerry Avorn articles convinced them to do more. What is important is the disclosure of the ties to Big Pharma including for Dr. Alan J Garber, who has some rather substantial conflicts of interest. These disclosures start on page 29 and while are not surprising, do show how tied to the drug companies most of the people are. This is just one more reason to be cautious about relying on the AACE diabetes algorithms.

What I find upsetting is the continued reference to the benefits of weight loss surgery or bariatric surgery as being the recommendation of preference. We know that this is not the cure-all claimed and many people are not able to maintain the strict diet required for bariatric surgery to be successful in the long term. The references chosen of course do not include the discussion in this Medical News Today article which emphasizes following the diet recommended for those that have bariatric surgery and receiving many if not most of the benefits.

I find the prediabetes section almost insulting as they say the primary goal of prediabetes management is weight loss as if everyone with prediabetes is overweight. I have met many patients with prediabetes that are not overweight. They continue that, when indicated, bariatric surgery can also be highly effective in preventing progression to diabetes. At least they felt obligated to say, weight loss may not directly address the pathogenesis of declining beta-cell function.

I am very surprised that no mention is made of medications being used “off label” because at present the FDA does not list any approved oral diabetes medications for prediabetes. Because metformin and acarbose are generic and relatively inexpensive to purchase, I can accept this. However, I think it would be wise for the drug manufacturers that the American Diabetes Association (ADA) and the AACE support with their dogma to have these approved. There are several other medications promoted in the Consensus that also should be on the approved list of drugs before they are used “off label.” These currently have FDA warnings, but AACE does not want the patient to know of them.

The AACE Diabetes Algorithms consensus statement is consistent in their promotion of weight loss and bariatric surgery as often the best option. They are also consistent in making readers aware of preventing hypoglycemia as a priority.

As I have time to study the consensus statement further, I will blog about it and I am hoping to see other professionals making statements about the consensus statement.

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