Position statement of the Australian Diabetes Society: individualisation of glycated haemoglobin targets for adults with diabetes mellitus

Cheung, N. Wah; Conn, Jennifer; d’Emden, Michael C; Gunton, Jenny E.; Jenkins, Alicia J.; Ross, Glynis P.; Sinha, Ashim; Andrikopoulos, Sofianos; Colagiuri, Stephen; Twigg, Stephen M.

doi:10.5694/j.1326-5377.2009.tb02819.x

Cited by 68 publications

(67 citation statements)

References 24 publications

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“…Recent findings of the United Kingdom Prospective Diabetes Study (UKPDS), Diabetes Complications and Control Trial (DCCT), and Australian National Health and Medical Research Council (NHMRC) guidelines recommend a cut-off at 7%. However, this may depend on type of diabetes, duration of diabetes, and comorbidities present (39, 40). Our study indicates that a BGL below the American Diabetes Society cut-off has no effect on HRV changes.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Autonomic Dysfunction in Type 2 Diabetes â€“ Effect of Hyperglycemia and Disease Duration

et al. 2014

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Heart rate variability (HRV) is reduced in diabetes mellitus (DM) patients, suggesting dysfunction of cardiac autonomic regulation and an increased risk for cardiac events. The aim of this paper was to examine the associations of blood glucose level (BGL), glycated hemoglobin (HbA1c), and duration of diabetes with cardiac autonomic regulation assessed by HRV analysis. Resting electrocardiogram (ECG), recorded over 20 min in supine position, and clinical measurements of 189 healthy controls and 93 type 2 DM (T2DM) patients were analyzed. HRV was assessed using several time-domain, frequency-domain, and non-linear methods. HRV parameters showed a clear difference between healthy controls and T2DM patients. Hyperglycemia was associated with increase in mean heart rate and decrease in HRV, indicated by negative correlations of BGL and HbA1c with mean RR interval and most of the HRV parameters. Duration of diabetes was strongly associated with decrease in HRV, the most significant decrease in HRV was found within the first 5–10 years of the disease. In conclusion, elevated blood glucose levels have an unfavorable effect on cardiac autonomic function and this effect is pronounced in long-term T2DM patients. The most significant decrease in HRV related to diabetes and thus presence of autonomic neuropathy was observed within the first 5–10 years of disease progression.

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Section: Discussionmentioning

confidence: 99%

Cardiac Autonomic Dysfunction in Type 2 Diabetes â€“ Effect of Hyperglycemia and Disease Duration

et al. 2014

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“…At the time of the study, the Australian Diabetes society mandated for even stricter hypertension targets with blood pressure (BP) targets <130/80 mmHg or <125/75 if proteinuria >1 g/day (11). These targets were used in our study.…”

Section: Methodsmentioning

confidence: 99%

Benchmarks of Diabetes Care in Men Living With Treated HIV-Infection: A Tertiary Center Experience

2018

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Treated human immunodeficiency virus (HIV) infection is associated with high rates of type 2 diabetes mellitus (DM), metabolic syndrome and central obesity/body fat partitioning disorders. To our knowledge, there are no available data comparing diabetes care in people with both HIV+DM vs. DM alone (DM-controls) within the same service and evaluating if benchmarked standards of care are being met in people with HIV+DM. This study evaluated the frequency that people with HIV+DM met the benchmarked American Diabetes Association (ADA) standards of care in diabetes (targets for HbA1c, blood pressure, lipid levels, complication screening, and healthy weight), compared to age- and sex- matched controls with diabetes, in an urban teaching hospital. The frequency of diabetes complications and rates of obesity and metabolic syndrome were also examined. All participants were male; individuals with HIV+DM (n = 30) were similar to DM-controls (n = 30) for age, diabetes duration and smoking status, but were more frequently non-obese compared to DM controls (92 vs. 55%, respectively, p = 0.003). Only 41% of HIV+DM met HbA1c targets, compared with 70% of DM-controls (p = 0.037). Blood pressure targets were poorly met in both HIV+DM and DM-controls: 43 vs. 23%, respectively (p = 0.12); LDL cholesterol targets were met in 65 vs. 67% (p = 1.0). Benchmarked complication screening rates were similar between HIV+DM vs. DM-controls for annual foot examination (53 vs. 67%, respectively, p = 0.29); biennial retinal examination (83 vs. 77%, respectively, p = 0.52); and annual urinary albumin measurement (77 vs. 67%, respectively, p = 0.39). The prevalence of diabetes complications was similar between HIV+DM compared to DM-controls: macrovascular complications were present in 23% in both groups (p = 1.0); the prevalence of microvascular complications was 40 vs. 30%, respectively (p = 0.51). Achieving the standard of care benchmarks for diabetes in people with both HIV-infection and diabetes is of particular importance to mitigate against the accelerated cardiometabolic outcomes observed in those with treated HIV infection. HIV+DM were less likely to achieve HbA1c targets than people with diabetes, but without HIV. People with HIV+DM may require specific strategies to ensure care benchmarks are met.

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“…Our review demonstrates that few clinical standards incorporate evidence about the increased risk of hypoglycemia in vulnerable diabetes patients even in the subset of guidelines meant to help clinicians individualize glycemic targets(Akalin et al 2009; Cheung et al 2009; Del Prato et al 2010; Skyler et al 2009) or specifically about treatment induced hypoglycemia(Cryer et al 2009). In addition, though a majority of guidelines state that targets should be individualized, no guideline reviewed provided clinicians with evidence or instruction about individualizing treatment targets in vulnerable patients.…”

Section: Discussionmentioning

confidence: 99%

Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review

Berkowitz

Aragon

Hines

et al. 2013

Health Services Research

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Objective To determine if diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients. Data Sources MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources. Study Design Systematic review of clinical standards (guidelines, quality metrics, or pay-for-performance programs) for glycemic control in adult diabetes patients. The primary outcome was discussion of increased risk for hypoglycemia in vulnerable populations. Data Collection/Extraction Methods Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form. Principal Findings We screened 1166 titles, and reviewed 220 manuscripts in full text. 44 guidelines, 17 quality metrics, and 8 pay-for-performance programs were included. 5 (11%) guidelines, and no quality metrics or pay-for-performance programs met the primary outcome. Conclusions Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations.

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Position statement of the Australian Diabetes Society: individualisation of glycated haemoglobin targets for adults with diabetes mellitus

Cited by 68 publications

References 24 publications

Cardiac Autonomic Dysfunction in Type 2 Diabetes â€“ Effect of Hyperglycemia and Disease Duration

Cardiac Autonomic Dysfunction in Type 2 Diabetes â€“ Effect of Hyperglycemia and Disease Duration

Benchmarks of Diabetes Care in Men Living With Treated HIV-Infection: A Tertiary Center Experience

Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review

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