The addition of E (Empowerment and Economics) to the ABCD algorithm in diabetes care

Khazrai, Yeganeh Manon; Buzzetti, Raffaella; Prato, Stefano Del; Cahn, Avivit; Pozzilli, Paolo

doi:10.1016/j.jdiacomp.2015.03.004

Cited by 19 publications

(21 citation statements)

References 63 publications

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“…Therefore, E (for empowerment) has now been added to the classical ABCD (Age, Body Weight, Complications, Duration of the Disease) algorithm in diabetes care [58]. Health care professionals should encourage the patient and improve their ability to make informed decisions concerning managing their own health, as well as improve their self-esteem and responsibility for their own health.…”

Section: Conclusion/summarymentioning

confidence: 99%

Empowerment in the Treatment of Diabetes and Obesity

Łuczyński

Głowińska-Olszewska

Bossowski

2016

Journal of Diabetes Research

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As the available therapies for diabetes and obesity are not effective enough, diabetologists and educators search for new methods to collaborate with patients in order to support their health behaviors. The aim of this review is to discuss perspectives for the development of new empowerment-type therapies in the treatment of diabetes/obesity. Empowerment is a process whereby patients gain the necessary knowledge to influence their own behavior to improve the quality of their lives. It is carried out in five stages: (1) identify the problem, (2) explain the feelings and meanings, (3) build a plan, (4) act, and (5) experience and assess the execution. Although many years have passed since the advent and popularization of the concept of empowerment, the area remains controversial, mainly with regard to the methodology of therapy. Some previous studies have confirmed the positive effect of empowerment on body weight, metabolic control, and quality of life of patients with type 2 diabetes; however, few studies have been conducted in patients with type 1 diabetes. There is still a need to confirm the effectiveness of empowerment in accordance with Evidence Based Medicine by performing long-term observational studies in a large group of patients. In future, empowerment may become part of the standard of care for patients with diabetes and/or obesity.

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Section: Conclusion/summarymentioning

confidence: 99%

Empowerment in the Treatment of Diabetes and Obesity

Łuczyński

Głowińska-Olszewska

Bossowski

2016

Journal of Diabetes Research

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“…First, individualization of the stringency by which glycemic control targets are set (1,(16)(17)(18)(19) has left many open questions regarding the best glycemic target for a given patient (20)(21)(22). While the ADA/EASD Position Statement (1,2) supports a target HbA 1c of ,7% for most patients, it recommends a more stringent target (HbA 1c 6.0-6.5%) for select patients, as long as it can be achieved without increased risk of hypoglycemia or other prominent side effects.…”

Section: Medical Guidelines For the Treatment Of Type 2 Diabetesmentioning

confidence: 99%

“…A large proportion of weight gain attributed to the initiation of insulin therapy can be avoided with simple lifestyle reinforcement measurements. In consideration of lifestyle modification or any other longterm treatment of type 2 diabetes, the importance of teamwork and patient empowerment cannot be underestimated (18,19). Teamwork includes a multidisciplinary team of nurses, dietitians, social workers, medical psychologists, and the treating physician.…”

Section: Medical Guidelines For the Treatment Of Type 2 Diabetesmentioning

confidence: 99%

“…At the same time, teamwork includes communication and shared responsibilities between the PHCT and the diabetologist/endocrinologist and timely referral of the more difficult-to-manage patients to specialists. Above all, teamwork refers to the involvement and empowerment of the patient and his or her immediate family and friends (18). In order to emphasize its importance, we added teamwork and patient empowerment to our suggested guidelines, alongside the recommendation for continued reinforcement of lifestyle modification (Fig.…”

Section: Medical Guidelines For the Treatment Of Type 2 Diabetesmentioning

confidence: 99%

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Treatment of Type 2 Diabetes: From “Guidelines” to “Position Statements” and Back

Mosenzon

Pollack

2016

Diabetes Care

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Given the increased prevalence of type 2 diabetes worldwide, most patients are treated by their primary health care team (PHCT). PHCTs need guidance in choosing the best treatment regimen for patients, since the number of glucoselowering agents (GLAs) is rapidly increasing, as is the amount of clinical data regarding these drugs. The American Diabetes Association/European Association for the Study of Diabetes Position Statement emphasizes the importance of personalized treatment and lists drug efficacy, risk of hypoglycemia, effect on weight, side effects, and cost as important parameters to consider when choosing GLAs. The suggested Israeli guidelines refocus earlier international recommendations from 2012 and 2015, based on emerging data from cardiovascular outcome trials as well as what we believe are important issues for patient care (i.e., durability, hypoglycemia risk, and weight gain).We suggest prioritizing glucose-lowering agents (GLAs) according to their effects on the parameters listed above as well as adherence to therapy and cardiovascular (CV) safety. We suggest, in parts of the world where it is economically feasible, treatment with second-line therapy drugs that have a decreased side effect profile, do not cause hypoglycemia or weight gain, and have established CV safety. Using these presumably "safer" drugs allows us to strive for tighter glucose control. The three groups of GLAs that meet these criteria are dipeptidyl peptidase (DPP)-4 inhibitors, glucagon-like peptide 1 receptor agonists (GLP-1 RAs), and sodium-glucose cotransporter (SGLT) 2 inhibitors. For patients with an HbA 1c .7.5% at diagnosis, initial combination therapy should be considered, and for those with symptomatic hyperglycemia or HbA 1c .9%, initial (possibly short-term) insulin therapy should be considered. For most patients, we consider BMI the leading reference for choosing between the three groups: DPP-4 inhibitors or SGLT2 inhibitors for BMI ,30 kg/m 2 , GLP-1 RAs or SGLT2 inhibitors for BMI 30-35 kg/m 2 , and GLP-1 RAs for BMI .35 kg/m 2 . Often, combination of two GLAs is not enough to achieve target glucose control; the addition of a third GLA can be determined by different patient characteristics including age, renal function, presence of previous CV disease, etc.

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“…However, it might be that preventing weight gain or fostering weight loss in the setting of T2D and obesity could be beneficial and worth initially higher medications costs as an investment for the future. The financial impact of new treatment modalities needs to be addressed at the individual level, local society, and globally 19 . We continue to increase our understanding of the factors that are common to T2D and obesity and affect their chronic nature.…”

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confidence: 99%