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Editorial illustrates shift away from glycemic control in diabetes treatment
Date:2/20/2014

BOSTON (February 20, 2014)An editorial in a February issue of American Family Physician proposes a simple way for physicians to communicate with patients about the best treatments for diabetes. The "lending a hand" illustration reprioritizes treatment goals, based on research on mortality reduction, to convey that glycemic control is no longer the primary intervention.

In order of benefit, to improve length and quality of life, patients with type 2 diabetes benefit from these interventions, starting with smoking cessation:

"Glycemic control is stuck in people's minds as the primary goal of treatment, but evidence has existed since the 1970s that other interventions are of greater benefit," said senior author Allen Shaughnessy, Pharm.D., M.Med.Ed., professor of family medicine at Tufts University School of Medicine and fellowship director of the Tufts University Family Medicine Residency Program at Cambridge Health Alliance.

Shaughnessy and colleagues wrote the editorial on their "lending a hand" illustration to demonstrate the paradigm shift in treatment priorities. "Lending a hand" emphasizes interventions that improve length and quality of life for those living with type 2 diabetes, in line with new guidelines from the American Diabetes Association and the European Association for the Study of Diabetes.

The "lending a hand" illustration uses the fingers of an open hand to depict diabetes interventions from thumb to pinky in descending order of benefit, relative to complications and mortality. Smoking cessation is considered the most important intervention (the thumb). Blood pressure control, metformin drug therapy, and lipid reduction follow along the pointer to ring finger. Glycemic control, considered the least important intervention, is relegated to the pinky.

"Some degree of glycemic control is necessary to prevent symptoms," Shaughnessy said. "It's just that the return on investment is low when
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Contact: Siobhan Gallagher
Siobhan.gallagher@tufts.edu
617-636-6586
Tufts University, Health Sciences Campus
Source:Eurekalert  

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