Calculating individualized glycaemic targets using an algorithm based on expert worldwide diabetologists: Implications in real-life clinical practice
Por:
Alvarez-Guisasola F, Cebrián-Cuenca AM, Cos X, Ruiz M, Millaruelo JM, Cahn A, Raz I, Orozco D and Spanish Society of Family Medicine Diabetes Group
Publicada:
1 mar 2018
Resumen:
BackgroundThe aim of this study was to assess the clinical implications of calculating an individualized HbA(1c) target using a recently published algorithm in a real-life clinical setting.
MethodsGeneral practitioners (GPs) from the Spanish Society of Family Medicine Diabetes Expert Group were invited to participate in the study. Each GP selected a random sample of patients with diabetes from his or her practice and submitted their demographic and clinical data for analysis. Individualized glycaemic targets were calculated according to the algorithm. Predictors of good glycaemic control were studied. The rate of patients attaining their individualized glycaemic target or the uniform target of HbA(1c)<7.0% was calculated.
ResultsForty GPs included 408 patients in the study. Of the 8 parameters included in the algorithm, comorbidities, risk of hypoglycaemia from treatment, and diabetes duration had the greatest impact on determining the individualized glycaemic target. Number of glucose-lowering agents and adherence were independently associated with glycaemic control. Overall, 60.5% of patients had good glycaemic control per individualized target, and 56.1% were well controlled per the uniform target of HbA(1c)<7.0% (P=.20). However, 12.8% (23 of 246) of the patients with HbA(1c)7.0% were adequately controlled per individualized target, and 2.6% (6 of 162) of the patients with HbA(1c)<7.0% were uncontrolled since their individualized target was lower.
ConclusionsIn a real-life clinical setting, applying individualized targets did not change the overall rate of patients with good glycaemic control yet led to reclassification of 7.1% (29 of 408) of the patients. More studies are needed to validate these results in different populations.
Filiaciones:
Alvarez-Guisasola F:
Ribera del Órbigo Primary Care Centre, Leon, Spain
Cebrián-Cuenca AM:
San Anton Primary Health Care Center, Cartagena, Spain
Cos X:
Sant Marti de Provencals Primary Health Care Center, University Autonomous Primary Care Research Institute Jordi Gol, Catalonian Health Institute, Barcelona, Spain
Ruiz M:
Agost Primary Health Care Center, Alicante, Spain
Millaruelo JM:
Primary Care Centre Torrero La Paz, Zaragoza, Spain
Cahn A:
The Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
Endocrinology and Metabolism Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
Raz I:
The Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
Orozco D:
Cathedra of Family Medicine, University Miguel Hernandez, Alicante, Spain
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