Using Multiple Measures of Glycemia to Support Individualized Diabetes Management: Recommendations for Clinicians, Patients, and Payers

TY - JOUR

T1 - Using Multiple Measures of Glycemia to Support Individualized Diabetes Management

T2 - Recommendations for Clinicians, Patients, and Payers

AU - Hirsch, Irl B.

AU - Amiel, Stephanie A.

AU - Blumer, Ian R.

AU - Bode, Bruce W.

AU - Edelman, Steven V.

AU - Seley, Jane J.

AU - Verderese, Carol A.

AU - Kilpatrick, Eric S.

PY - 2012/11/26

Y1 - 2012/11/26

N2 - By the year 2030, the diabetes pandemic will likely affect more than 10% of the world's population. The personal, public health, and economic crises implicit in this trend call for decisive action. Yet, escalating dilemmas thwart full realization of current therapies. First, controversial studies, such as the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial, have amplified calls to individualize glycated hemoglobin (A1C) targets in the absence of adequate infrastructures for supporting personalized care. Second, costlier medications and technologies addressing more nuanced aspects of metabolic dysfunction are expanding options for diabetes management amidst growing disparities between "affordable" and "best" care. Third, common clinical quandaries, such as discrepancies between A1C and self-monitoring of blood glucose data, as well as misconceptions about long-term glycemic assessment, compound entrenched cycles of inadequate self-care, delayed intervention, and suboptimal glycemic outcomes. Because individual, clinical, and public policy responses to these conflicting forces are based largely on methodologies for glucose measurement, a panel of clinical experts from Europe and North America was convened to reexamine our glucose measuring tools and determine ways in which they can be better applied toward more purposeful processes of glycemic management. Among the main issues addressed were the need for caution in interpreting A1C for individual patients, the role of alternative biomarkers in identifying aspects of glycemic dysregulation not captured by A1C, and the value of using patients' own glucose data to consolidate therapeutic, educational, and behavior-change objectives.

AB - By the year 2030, the diabetes pandemic will likely affect more than 10% of the world's population. The personal, public health, and economic crises implicit in this trend call for decisive action. Yet, escalating dilemmas thwart full realization of current therapies. First, controversial studies, such as the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial, have amplified calls to individualize glycated hemoglobin (A1C) targets in the absence of adequate infrastructures for supporting personalized care. Second, costlier medications and technologies addressing more nuanced aspects of metabolic dysfunction are expanding options for diabetes management amidst growing disparities between "affordable" and "best" care. Third, common clinical quandaries, such as discrepancies between A1C and self-monitoring of blood glucose data, as well as misconceptions about long-term glycemic assessment, compound entrenched cycles of inadequate self-care, delayed intervention, and suboptimal glycemic outcomes. Because individual, clinical, and public policy responses to these conflicting forces are based largely on methodologies for glucose measurement, a panel of clinical experts from Europe and North America was convened to reexamine our glucose measuring tools and determine ways in which they can be better applied toward more purposeful processes of glycemic management. Among the main issues addressed were the need for caution in interpreting A1C for individual patients, the role of alternative biomarkers in identifying aspects of glycemic dysregulation not captured by A1C, and the value of using patients' own glucose data to consolidate therapeutic, educational, and behavior-change objectives.

KW - TARGETING POSTPRANDIAL HYPERGLYCEMIA

KW - BLOOD-GLUCOSE

KW - MICROVASCULAR COMPLICATIONS

KW - SELF-MANAGEMENT

KW - CARDIOVASCULAR EVENTS

KW - AMERICAN-COLLEGE

KW - RISK

KW - INSULIN

KW - VARIABILITY

KW - TRIAL

U2 - 10.1089/dia.2012.0132

DO - 10.1089/dia.2012.0132

M3 - Literature review

SN - 1520-9156

VL - 14

SP - 973

EP - 983

JO - Diabetes Technology and Therapeutics

JF - Diabetes Technology and Therapeutics

IS - 11

M1 - N/A

ER -