Breaking down “individualized therapy” and five big questions to help patients and providers make it a reality…
By Kelly Close
How are things going for you?
And, more important, what can be done to make things better?
Broad questions, I know, but crucial in every part of life – especially diabetes. This month I’ve been thinking even more than usual about my own goals and strategies, thanks to a new position statement from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). It’s called “Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach.” Although the specific treatments discussed in the guidelines are for people with type 2 diabetes, we found that many of the “patient-centered” principles apply to type 1 as well.
Ten authors and dozens of collaborators (many of whom we are honored to have on our advisory board at diaTribe) worked for two years to produce the document, which replaces a 2009 ADA/EASD “consensus algorithm” for type 2 diabetes. The 2009 algorithm (a flow chart), which was not actually officially endorsed by the ADA or EASD, gave clear preference to drugs that were more established and less expensive. This framework was introduced as part of a longer paper that explained the pros and cons of different therapies, but the main graphic did not make as clear why a patient might benefit from one combination versus another. By contrast, the main graphic of the new position statement gives a detailed picture of all the main drug classes based on glucose-lowering effectiveness, risk of causing hypoglycemia, effect on weight, risk of causing non-hypoglycemia-related side effects, and cost. In keeping with its “patient-centered approach,” the position statement also includes recommendations for starting on insulin therapy, as well as guidance on A1c goals. The strong, consistent message throughout is that every individual with diabetes is different and deserves his or her own treatment plan. This, sadly, is not always the case in today’s rushed healthcare system. But it is how things ought to be.
The new document is not simple, but of course neither is diabetes, especially given the large (and growing) number of medications available. We think that the document does a good job of guiding people through this complexity and of emphasizing the importance of the individual patient.
To help you and your healthcare provider make the most of the new position statement, we drafted some questions that center on goals and medical treatments (available for download here). These are by no means recommendations – just five questions to start a conversation and aid your own thinking.
I wish there were one single path that was best for everyone. But since there isn’t, I will simply say: good luck as you continue to find your own way, and thank you for sharing that journey with us.
Very best,
Kelly
