Management of Hyperglycemia in Type 2 Diabetes
Usually accompanying pharmacogenetics, genomics and cancer medicine, personalized medicine is a medical model emphasizing the customization of healthcare, with all decisions and practices being tailored to individual patients in whatever ways possible. Development strategies that administer therapies to unselected populations will perhaps become a strategy of the past. However, physician feeling and conviction about the willingness to reach the HbA1c target (now tailored on the patient) remains paramount to reduce unnecessary therapeutic inertia. Suggested choices within the algorithm represent the best compromise among the scientific evidence of efficacy and safety coming from RCTs, and the translation in the real word of type 2 diabetes.
For the pragmatic physician, however, the evidence that intensive glycemic control may give benefit on microvascular complications of type 2 diabetes may be just enough to accept and propose it for most diabetic patients. This, however, must be tempered with the evidence that intensive glycemic control increases the risk of severe hypoglycemia. Fourteen clinical trials that randomized 28 614 participants with type 2 diabetes (15 269 to intensive control and 13 345 to conventional control) were included in a meta-analysis that considered the effects of intensive glycemic control irrespective of differences among trials in individual targets or achieved glycemic control.
Personalized diabetology has the potential to improve the quality healthcare practice of diabetes management, but specific research is needed. Personalized diabetology should also take advantage from technological advances and interventions involving mobile applications that may have a positive impact on diabetes self-management. A recent controlled study suggests that a nurse-led online disease management program can achieve greater decreases in A1C at 6 months, although the differences were not sustained at 12 months. It is not by chance that AMD has launched an interventional, national-planned, trial specifically devoted to test the hypothesis whether a strict adherence to the personalized treatment plans would result in better outcomes for type 2 diabetic patients.
Is Personalized Diabetology the Answer?
Usually accompanying pharmacogenetics, genomics and cancer medicine, personalized medicine is a medical model emphasizing the customization of healthcare, with all decisions and practices being tailored to individual patients in whatever ways possible. Development strategies that administer therapies to unselected populations will perhaps become a strategy of the past. However, physician feeling and conviction about the willingness to reach the HbA1c target (now tailored on the patient) remains paramount to reduce unnecessary therapeutic inertia. Suggested choices within the algorithm represent the best compromise among the scientific evidence of efficacy and safety coming from RCTs, and the translation in the real word of type 2 diabetes.
For the pragmatic physician, however, the evidence that intensive glycemic control may give benefit on microvascular complications of type 2 diabetes may be just enough to accept and propose it for most diabetic patients. This, however, must be tempered with the evidence that intensive glycemic control increases the risk of severe hypoglycemia. Fourteen clinical trials that randomized 28 614 participants with type 2 diabetes (15 269 to intensive control and 13 345 to conventional control) were included in a meta-analysis that considered the effects of intensive glycemic control irrespective of differences among trials in individual targets or achieved glycemic control.
Personalized diabetology has the potential to improve the quality healthcare practice of diabetes management, but specific research is needed. Personalized diabetology should also take advantage from technological advances and interventions involving mobile applications that may have a positive impact on diabetes self-management. A recent controlled study suggests that a nurse-led online disease management program can achieve greater decreases in A1C at 6 months, although the differences were not sustained at 12 months. It is not by chance that AMD has launched an interventional, national-planned, trial specifically devoted to test the hypothesis whether a strict adherence to the personalized treatment plans would result in better outcomes for type 2 diabetic patients.
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