People with type 2 diabetes should be given individually tailored self-management plans and made part of any health decisions which involve their treatment, according to new US guidelines.
The 2017 Clinical Practice Guideline (CPG) for the Management of Type 2 Diabetes Mellitus in Primary Care includes updates on diabetes management within seven key areas. These include hospital care, HbA1c target levels and care which puts the patient at the centre of their own healthcare plan.
Official US guidelines about the treatment and management of type 2 diabetes, published by the American Diabetes Association (ADA), already exist, but this document focuses more on personal treatment and target levels based on the individuals’ health at the time.
The authors wrote: “The [guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalising treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events.”
One of the recommendations stated it “strongly encourages” healthcare professionals to ensure decision making about treatment is shared with the patient so the person can have a say about their own care plan. They wrote: “shared decision-making reinforces a trusted therapeutic relationship and increases patient satisfaction.”
It was also suggested that HbA1c targets should be set for each person depending on their general health, other illnesses and life expectancy, making them “tailored to a patient’s unique characteristics and goals of care”.
The guidance also included recommendations on glucose control for people in hospital. They said aggressive glucose control is not a good idea because “achieving near-normal glucose levels in hospitalised patients without risk for hypoglycemia can be challenging”.
The document also referred to how race can affect glycemic control and HbA1c levels. It has been published in the Annals of Internal Medicine.
The most recent National Institute of Care and Excellence (NICE) update for people with type 2 diabetes in the UK came in 2017, when guidelines reflected new information on drug treatments and algorithms for blood glucose-lowering therapy.

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