Diabetes Q&A

VA, DoD Develop Diabetes Clinical Practice Guidelines

The US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) have released a joint clinical practice guideline for the management of type 2 diabetes mellitus.

The guidelines were based upon a literature review conducted by a panel of multidisciplinary clinicians and the ECRI Institute, and emphasize personalizing treatment based upon evaluation of patient risk and the results of major trials. 
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Among the recommendations:

  • Provide patient-centered care and incorporate shared decisions making
  • Assess patient characteristics and nonglycemic factors when interpreting the results of hemoglobin A1c, fructosamine, and other biomarker testing
  • Set HbA1c target ranges based on absolute reduction in risk for significant microvascular complications
  • Develop individualized treatment plans
  • Select pharmaceutical agents based on efficacy, contraindications, drug interactions, and comorbidities

“In summary, the VA/DoD [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events,” the authors concluded.

“Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice.”

—Michael Potts

Reference:

Conlin PR, Colburn J, Aron D, et al. Synopsis of the 2017 U.S. department of veterans affairs/U.S. department of defense clinical practice guideline: management of type 2 diabetes mellitus [published online October 24, 2017]. Ann Intern Med. doi:10.7326/M17-1362.