Magazine article Clinical Psychiatry News

Group Calls for 'Uncompromising' Diabetes Care

Magazine article Clinical Psychiatry News

Group Calls for 'Uncompromising' Diabetes Care

Article excerpt

WASHINGTON -- Diabetes must be managed with an "uncompromising insistence to treat to target," according to new guidelines issued by the American College of Endocrinology and the American Association of Clinical Endocrinologists.

The document is aimed at putting an end to the common practice of letting diabetic patients languish for months or years with high hemoglobin [A.sub.1c] levels before stepping up therapy. It also places increased emphasis on postprandial glucose values in addition to fasting levels, and on the use of combination therapy along with lifestyle intervention.

Treatment targets--a hemoglobin [A.sub.1c] value of 6.5% or less (lower than the target of less than 7% recommended by the American Diabetes Association), fasting/preprandial glucose levels less than 110 mg/dL, and 2-hour postprandial glucose less than 140 mg/dL--were first issued by the AACE in 2002 (Endocr. Pract. 2002;8[suppl. 1]:40-82).

"We prefer to get them to target from day 1 and keep them there," Jaime A. Davidson, M.D., an endocrinologist at the University of Texas, Dallas, said at a press briefing following a 2-day consensus conference.

Given recent data suggesting that postprandial glucose values may begin to rise sooner than fasting glucose in the evolution of diabetes, the AACE panel also recommended that the diagnosis of diabetes be made with a 2-hour oral glucose tolerance test (OGTT) in individuals at high risk, rather than with an initial fasting blood sugar screen. Conference coorganizer Paul S. Jellinger, M.D., acknowledged that this might be somewhat controversial. But "finding a normal [fasting] blood sugar in a high-risk individual or even impaired fasting glucose (100-110 mg/dL) will miss many patients with impaired glucose tolerance/diabetes," said Dr. Jellinger, who practices in Hollywood, Fla., and is president of the American College of Endocrinology.

The American Diabetes Association disagrees. The ADA's expert committee discussed this issue at its meeting prior to the publication of its own report, which lowered the normal fasting blood glucose from 110 mg/dL to 100 mg/dL (Diabetes Care 2005;28[suppl. 1]:S37-S42). "They continue to feel that the best first test is the fasting. The 2-hour OGTT should be used if a question remains after getting the fasting," Nathaniel G. Clark, M.D., national vice president of clinical affairs for the ADA, told this newspaper.

But experts do agree that significant cardiovascular disease develops years before the onset of diabetes and is strongly associated with hyperglycemia. …

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