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Computer algorithm can generate a personalised HbA1c target for people with type 2 diabetes

A newly-developed computer-based algorithm could help healthcare professionals determine the appropriate HbA1c target for individual type 2 diabetes patients, according to new research.
The study, conducted by researchers at Diabetes Research Centre, Hadassah Hebrew University Medical Centre, Jerusalem, Israel, allows for the “patient-centred” approach to type 2 diabetes management called for in 2012 by the American Diabetes Association and the European Association for the Study of Diabetes.
The position statement released in 2012 argues that the diverse range of factors affecting type 2 diabetes patients – including age and complications – make a “one-size-fits-all” attempt to HbA1c management unworkable.
However, with personalised HbA1c targets, it is difficult to judge the performance of healthcare professionals at a glance. It is, the researchers acknowledge, a “grey zone.”
“Physicians are often assessed by the HbA1c of their patients, and therefore a physician whose patients include elderly individuals with increasing comorbidities may not be fairly judged,” Avivit Cah, MD, of the Diabetes Research Center, Hadassah Hebrew University Medical Center, Jersusalem, Israel, told Medscape Medical News.
The researchers conducted surveys to find out which factors healthcare professionals think should be taken into account when it came to determining the HbA1c target for an individual patient. The researchers then assigned points to each factor, allowing healthcare professionals to input numbers from their patient’s medical record to receive a personalised HbA1c target.
“The formula is intended for use in all type 2 diabetes patients, as it takes into account each patient’s unique characteristics. It is meant to be a supportive decision-making tool for the physicia, though it cannot replace the physician’s own clinical intuitio,” Dr. Cahn explained.
Anne L. Peters, MD, professor of clinical medicine and director of clinical diabetes programs, Keck School of Medicine, University of Southern California, Los Angeles, told Medscape Medical News:
“Physicians are feeling more and more trapped by numbers and metrics we have to reach, and I think there has to be a way to individualise those that makes sense based on individual disease characteristics.”
Peters did, however, consider it to be just a “first step”.
“This is about getting the physician to understand that in their heads they need to have an idea of what they’re working towards and then add in the patient perspective. This isn’t an algorithm that needs to be rigidly applied, but it’s to get the conversation moving.
“We’re all measured now by metrics…I really reject that, because I see patients who are more difficult or sicker, and I need adjusted targets…It’s not appropriate to have a ‘one-size-fits-all’ number that you’re judging me by in terms of patient care,” said Dr. Peters.
“You need to take this for what it is, but honestly we have to be having this conversation. We have to be able to help providers with this…You have to start somewhere. I don’t think people will wholesale adopt it, but it’s a step.”
The findings are published in Diabetes Care.

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