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

Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia.
The Medical journal of Australia (Impact Factor: 4.09). 09/2009; 191(6):339-44.
Source: PubMed


Tight glycaemic control reduces the risk of development and progression of organ complications in people with type 1 or type 2 diabetes. In this position statement, the Australian Diabetes Society recommends a general target glycated haemoglobin (HbA(1c)) level of </= 7.0% for most patients. This position statement also provides guidelines for the individualisation of glycaemic targets to a tighter or lesser degree, with a recommended target HbA(1c) level of </= 6.0% in some people, or up to </= 8.0% in others. Individualisation of the HbA(1c) target is based on patient-specific factors, such as the type of diabetes and its duration, pregnancy, diabetes medication being taken, presence of cardiovascular disease, risk of and problems from hypoglycaemia, and comorbidities. Management of diabetes also includes: adequate control of other cardiovascular risk factors, including weight, blood pressure and lipid serum levels; antiplatelet therapy; and smoking cessation.

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    • "All identified studies, except Shera et al., included patients attending tertiary care hospitals, and all, but one used retrieved data from patient's records and data quality is questionable. Many of these studies chose cut-offs for HbA1c levels that were not congruent with cut-offs put forth by major international guidelines for categorizing patients as regards their DM control (Table 1) [7] [8] [9] [10]. Rationales for selecting a particular cut-off were either inadequately cited or not provided in respective reports. "
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    ABSTRACT: Aims This study aimed to explore the prevalence of, and factors associated with, uncontrolled diabetes mellitus (UDM) in a community setting in Pakistan. Methodology: A single-center, cross-sectional study, conducted in a community-based specialized care center (SCC) for diabetes in District Central Karachi, in 2003, registered 452 type 2 DM participants, tested for HbA1c and interviewed face-to-face for other information. Logistic regression analysis was conducted to identify factors associated with UDM. Results Prevalence of UDM among diabetes patients was found to be 38.9% (95%CI: 34.4% - 43.4%). Multivariable logistic regression model analysis indicated that age <50 years (OR: 1.9; 95% CI: 1.2 - 2.9), being diagnosed in a hospital (vs. a clinic) (OR: 1.8; 95% CI: 1.1 - 2.8), diabetes information from a doctor or nurse only (vs. multiple sources) (OR: 1.8; 95% CI: 1.2 - 2.9), higher monthly treatment cost (OR: 1.3; 95% CI: 1.1 - 1.6; for every extra 500PKR), and higher consumption of tea (OR: 1.5; 95% CI: 1.0 - 2.2; for every 2 extra cups) were independently associated with UDM. Conclusion The prevalence of UDM was approximately 39% among persons with type 2 diabetes visiting a community based SCC for diabetes. Modifiable risk factors such as sources of diabetes information and black tea consumption can be considered as potential targets of interventions in karachi.
    Diabetes Research and Clinical Practice 10/2014; 107(1). DOI:10.1016/j.diabres.2014.09.025 · 2.54 Impact Factor
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    • "Conversely, achieving optimal glycaemic control early in the course of the disease reduces the risk of vascular complications as well as mortality [7]. The most recent Australian Diabetes Society (ADS) guidelines [8] recommend individualized glycaemic targets (HbA1c) based upon diabetes duration, age, and co-morbidity, yet in Australia, only 52% of people with T2D achieve an HbA1c below 7% (53 mmol/mol). "
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    ABSTRACT: Type 2 diabetes (T2D) brings significant human and healthcare costs. Its progressive nature means achieving normoglycaemia is increasingly difficult, yet critical to avoiding long term vascular complications. Nearly one-half of people with T2D have glycaemic levels out of target. Insulin is effective in achieving glycaemic targets, yet initiation of insulin is often delayed, particularly in primary care. Given limited access to specialist resources and the size of the diabetes epidemic, primary care is where insulin initiation must become part of routine practice. This would also support integrated holistic care for people with diabetes. Our Stepping Up Program is based on a general practitioner (GP) and practice nurse (PN) model of care supported appropriately by endocrinologists and credentialed diabetes educator-registered nurses. Pilot work suggests the model facilitates integration of the technical work of insulin initiation within ongoing generalist care. This protocol is for a cluster randomized controlled trial to examine the effectiveness of the Stepping Up Program to enhance the role of the GP-PN team in initiating insulin and improving glycaemic outcomes for people with T2D. 224 patients between the ages of 18 and 80 years with T2D, on two or more oral hypoglycaemic agents and with an HbA1c >=7.5% in the last six months will be recruited from 74 general practices. The unit of randomization is the practice.Primary outcome is change in glycated haemoglobin HbA1c (measured as a continuous variable). We hypothesize that the intervention arm will achieve an absolute HbA1c mean difference of 0.5% lower than control group at 12 months follow up. Secondary outcomes include the number of participants who successfully transfer to insulin and the proportion who achieve HbA1c measurement of <7.0%. We will also collect data on patient psychosocial outcomes and healthcare utilization and costs. The study is a pragmatic translational study with important potential implications for people with T2D, healthcare professionals and funders of healthcare though making better use of scarce healthcare resources, improving timely access to therapy that can improve disease outcomes.Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12612001028897.
    Implementation Science 02/2014; 9(1):20. DOI:10.1186/1748-5908-9-20 · 4.12 Impact Factor
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    • "GOALS Blood pressure: systolic BP 140 [19] (American Diabetes Association) or 130/80 [20] (Australian Guidelines). Glycaemic goals: HbA 1c <7% (53 mmol/mol)as a general goal [19] [21] and for a person requiring any anti-diabetic agents other than metformin or insulin without cardiovascular disease, the goal may be reduced to 6.5% (48 mmol/mol) [19] [21]. Lipid goals: total cholesterol <4.0 mmol/L; HDL-C 1.0 mmol/ L; LDL-C <2.0 mmol/L; TG <2.0 mmol/L [20]. "
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    ABSTRACT: Integrative care of patients with type 2 diabetes requires an understanding of the patient's lifestyle, motivations and natural history of their diabetes. This individualised approach integrating elements of the medical framework and evidence based lifestyle, nutritional and other complementary approaches can assist patient outcomes.
    01/2014; 1(1):55–58. DOI:10.1016/j.aimed.2013.08.005
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