Clinical Assessment of Individualized Glycemic Goals in Patients With Type 2 Diabetes: Formulation of an Algorithm Based on a Survey Among Leading Worldwide Diabetologists

Abstract

OBJECTIVEObservations over the past few years have demonstrated the need to adjust glycemic targets based on parameters pertaining to individual patient characteristics and comorbidities. However, the weight and value given to each parameter will clearly vary depending on the experience of the provider, the characteristics of the patient, and the specific clinical situation.RESEARCH DESIGN AND METHODSTo determine if there is current consensus on a global level with regard to identifying these parameters and their relative importance, we conducted a survey among 244 key worldwide opinion-leading diabetologists. Initially, the physicians were to rank the factors they take into consideration when setting their patients' glycemic target according to their relative importance. Subsequently, six clinical vignettes were presented, and the experts were requested to suggest an appropriate glycemic target. The survey results were used to formulate an algorithm according to which an estimate of the patient's glycemic target based on individualized parameters can be computed. Three additional clinical cases were submitted to a new set of experts for validation of the algorithm.RESULTSA total of 151 (61.9%) experts responded to the survey. The parameters “life expectancy” and “risk of hypoglycemia from treatment” were considered to be the most important. “Resources” and “disease duration” ranked the lowest. An algorithm was constructed based on survey results. It was validated by presenting three new cases to 57 leading diabetologists who suggested glycemic targets that were similar to those calculated by the algorithm.CONCLUSIONSThe resultant suggested algorithm is an additional decision-making tool offered to the clinician to supplement clinical decision making when considering a glycemic target for the individual patient with diabetes.

Association between BMI and risk of severe hypoglycaemia in type 2 diabetes

“…In the recent trend toward individualization of diabetes care, hypoglycemia has been considered as a major barrier to optimal glucose control (which helps in preventing diabetes complications). One recent survey among global opinion leaders in diabetes showed that “the risk of hypoglycemia from treatment” and “the risk associated with hypoglycemia” were important factors that should be considered when setting patients’ glycemic targets [2]. Severe hypoglycemia is defined as an episode of hypoglycemia in which a person’s blood glucose levels become extremely low, requiring the assistance of another person for treatment [3].…”

Hypoglycaemia manifestations and recurrent events: Lessons from the SAVOR‐TIMI 53 outcome study

“…The lower HbA1c in these participants may either represent their propensity for developing hypoglycaemia, which leads to lower than average glucose levels, or may indicate an attempt to intensify glucose control, which can possibly lead to recurrent hypoglycaemic events. The glycaemic target of vulnerable participants must be carefully considered, when intensifying treatment with agents that might cause hypoglycaemia and a more lenient HbA1c target may therefore be considered appropriate in these patients …”

A Proposal for an Out-of-Range Glycemic Population Health Safety Measure for Older Adults With Diabetes

“…In a recent scenario-based survey evaluating endocrinologists’ perspectives on individualized glycemic target goals based on clinical factors, wide variation existed, with many choosing HbA 1c targets both lower and greater than 8% (64 mmol/mol), even in patients with significant comorbid conditions (32). In addition, individual patient preferences differ.…”