Professional Section Quarterly - Spring 2012 - (Page 2)

continued from page 1 Clinical News cont. from page 1 of its Government Relations Committee and its Pregnancy Council, and as president of the Washington Area Affiliate. He also recently completed six years as the Association’s representative on the steering committee of the National Diabetes Education Program. Ratner received his medical degree from Baylor College of Medicine in Houston, Tex., where he also completed his internal medicine training. He underwent fellowship training in endocrinology and metabolism at Harvard Medical School and the Joslin Diabetes Center in Boston. He recently completed a sabbatical as a Robert Wood Johnson Foundation Health Policy Fellow. As part of this fellowship, Ratner served as the study director for the Institute of Medicine Committee on Comparative Effectiveness Research Prioritization and as a program examiner for health reform in the Health Division of the U.S. Office of Management and Budget. A Principal Investigator for the Diabetes Prevention Program (DPP) and the DPP Outcomes Study of the National Institutes of Health (NIH), Ratner served on the steering committee for the program nationwide. He also previously sat on the boards of directors of the National Certification Board for Diabetes Educators and the American Association of Diabetes Educators. Ratner’s research interests include diabetes therapeutics and complications, with an emphasis on translational efforts from controlled trials into community-based practice. He is the author of more than 130 original scientific articles and 20 book chapters, and was an associate editor of the Journal of Clinical Endocrinology and Metabolism. ▲ 2 ers, and increasing calls for a move toward more patientcentered care.” The authors emphasize that a patient-centered approach is “particularly appropriate” in type 2 diabetes, given the general lack of comparativeeffectiveness evidence to inform the choice and sequence of therapy. The authors also note that while the statement’s focus is on glycemic control, management should include a major focus on cardiovascular risk reduction, since type 2 diabetes is a major risk factor for cardiovascular events and mortality. “Our intent is … to encourage an appreciation of the variable and progressive nature of type 2 diabetes, the specific role of each drug, the patient and disease factors that drive clinical decision making, and the constraints imposed by age and comorbidity,” the statement authors wrote. Reflecting results from type 2 diabetes cardiovascular trials that suggest that not everyone benefits from aggressive glucose management, the statement reinforces existing ADA recommendations to base HbA1c goals on a number of patient characteristics, including life expectancy, extent of complications, and presence of important comorbidities. The statement includes a diagram with “ramps” for common patient characteristics that might influence whether a more- or lessstringent effort to lower HbA1c should be considered. All patients should receive diabetes education, in an individual or group setting, with personalized dietary advice and a focus on the importance of increased physical activity, the statement says. Setting a goal of weight reduction, or least weight maintenance, is also recommended. The statement advises that metformin remains the best first-line medication choice, if tolerated and not contraindicated. In a departure from previous guidance, the statement does not specify what agents should be used if monotherapy is insufficient. The lack of long-term comparative-effectiveness data on the many second agents now available means that rigid recommendations on combination therapy cannot be made, the authors state. Instead, the statement provides a framework to help health care professionals individualize treatment plans for patients. A table lists the important properties and advantages and disadvantages of the many glucoselowering agents now available. A diagram sets out general recommendations on potential sequences of antihyperglycemic therapy. Supplementary diagrams accompanying the main text show ways of adapting the general recommendations to several specific patient situations, such as when a major goal is to avoid weight gain. Finally, another figure in the statement illustrates sequential insulin strategies for those type 2 diabetic patients who need insulin therapy. The position statement authors summarize their recommendations in a list of key points that can be found on the back of this issue of the Professional Section Quarterly. To read the position statement and accompanying materials online, see profes sional.diabetes.org/MHT2. ADA Launches New Podcast for Health Care Professionals DA invites you to tune in to Diabetes Core Update, a free monthly podcast that presents and discusses the latest clinically relevant articles from Professional Section Quarterly A http://professional.diabetes.org/MHT2 http://professional.diabetes.org/MHT2

Table of Contents for the Digital Edition of Professional Section Quarterly - Spring 2012

Professional Section Quarterly - Spring 2012