Individualizing Glycemic Targets in Type 2 Diabetes Mellitus
Authors: David Aron, Paul R. Conlin, Curtis Hobbs, Robert A. Vigersky, Leonard Pogach
Journal: Annals of Internal Medicine (2011)

Letters6 September 2011Individualizing Glycemic Targets in Type 2 Diabetes MellitusDavid Aron, MD, MS, Paul R. Conlin, MD, Curtis Hobbs, MD, Robert A. Vigersky, MD, and Leonard Pogach, MD, MBADavid Aron, MD, MSFrom Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106; Boston Veterans Affairs Medical Center, Boston, MA 02130; Madigan Healthcare System, Tacoma, WA 98431; Walter Reed Health Care System, Washington, DC 20307; and New Jersey Veterans Affairs Healthcare System, East Orange, NJ 07018.Search for more papers by this author, Paul R. Conlin, MDFrom Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106; Boston Veterans Affairs Medical Center, Boston, MA 02130; Madigan Healthcare System, Tacoma, WA 98431; Walter Reed Health Care System, Washington, DC 20307; and New Jersey Veterans Affairs Healthcare System, East Orange, NJ 07018.Search for more papers by this author, Curtis Hobbs, MDFrom Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106; Boston Veterans Affairs Medical Center, Boston, MA 02130; Madigan Healthcare System, Tacoma, WA 98431; Walter Reed Health Care System, Washington, DC 20307; and New Jersey Veterans Affairs Healthcare System, East Orange, NJ 07018.Search for more papers by this author, Robert A. Vigersky, MDFrom Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106; Boston Veterans Affairs Medical Center, Boston, MA 02130; Madigan Healthcare System, Tacoma, WA 98431; Walter Reed Health Care System, Washington, DC 20307; and New Jersey Veterans Affairs Healthcare System, East Orange, NJ 07018.Search for more papers by this author, and Leonard Pogach, MD, MBAFrom Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106; Boston Veterans Affairs Medical Center, Boston, MA 02130; Madigan Healthcare System, Tacoma, WA 98431; Walter Reed Health Care System, Washington, DC 20307; and New Jersey Veterans Affairs Healthcare System, East Orange, NJ 07018.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-5-201109060-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The recent article by Ismail-Beigi and colleagues (1) emphasizes that one size does not fit all when it comes to hemoglobin A1c goals for patients with diabetes—an important and increasingly recognized conclusion in light of recent large randomized, controlled trials. However, the assertion that “Each organization discusses the importance of individualizing glycemic goals but provides little guideline on how this should be done” is not correct.The VA/DoD [Veterans Affairs/Department of Defense] Clinical Practice Guidelines for Diabetes have included stratified targets based on life expectancy and comorbid conditions for more than 10 years (2–4). Moreover, all of ...References1. Ismail-Beigi F, Moghissi E, Tiktin M, Hirsch IB, Inzucchi SE, Genuth S. Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann Intern Med. 2011;154:554-9. [PMID: 21502652] LinkGoogle Scholar2. Pogach LM, Brietzke SA, Cowan CL, Conlin P, Walder DJ, Sawin CT; VA/DoDDiabetes Guideline Development Group. Development of evidence-based clinical practice guidelines for diabetes: the Department of Veterans Affairs/Department of Defense guidelines initiative. Diabetes Care. 2004;27 Suppl 2 B82-9. [PMID: 15113788] CrossrefMedlineGoogle Scholar3. Management of Diabetes Mellitus Guideline Update Working Group. VA/DoD clinical practice guideline for the management of diabetes mellitus. Washington, DC: U.S. Department of Veterans Affairs. Accessed at www.healthquality.va.gov/diabetes/DM2010_SUM-v4.pdf on 8 March 2011. Google Scholar4. Pogach L, Conlin PR, Hobbs C, Vigersky RA, Aron D; for the VA/DoD Diabetes Guideline Working Group. VA/DoD update of diabetes guidelines: what clinicians need to know about absolute risk of benefits and harms and A1c laboratory accuracy. Fed Practit. 2011;:39-44. Google Scholar5. Little RR, Rohlfing CL, Sacks DB; National Glycohemoglobin Standardization Program (NGSP) Steering Committee. Status of hemoglobin A1c measurement and goals for improvement: from chaos to order for improving diabetes care. Clin Chem. 2011;57:205-14. [PMID: 21148304] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: David Aron, MD, MS; Paul R. Conlin, MD; Curtis Hobbs, MD; Robert A. Vigersky, MD; Leonard Pogach, MD, MBAAffiliations: From Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106; Boston Veterans Affairs Medical Center, Boston, MA 02130; Madigan Healthcare System, Tacoma, WA 98431; Walter Reed Health Care System, Washington, DC 20307; and New Jersey Veterans Affairs Healthcare System, East Orange, NJ 07018.Disclaimer: The opinions expressed herein are those of the authors and do not necessarily reflect those of the U.S. government or any of its agencies.Disclosures: The authors are members of the VA/DoD Diabetes Guideline Working Group. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIndividualizing Glycemic Targets in Type 2 Diabetes Mellitus: Implications of Recent Clinical Trials Faramarz Ismail-Beigi , Etie Moghissi , Margaret Tiktin , Irl B. Hirsch , Silvio E. Inzucchi , and Saul Genuth Metrics Cited byComparison between the Therapeutic Effect of Metformin, Glimepiride and Their Combination as an Add-On Treatment to Insulin Glargine in Uncontrolled Patients with Type 2 DiabetesEvidence-Informed Guidelines for Treating Frail Older Adults With Type 2 Diabetes: From the Diabetes Care Program of Nova Scotia (DCPNS) and the Palliative and Therapeutic Harmonization (PATH) Program 6 September 2011Volume 155, Issue 5Page: 340-341KeywordsAttentionClinical laboratoriesConflicts of interestHemoglobinHypoglycemiaLife expectancySafetyTreatment guidelinesType 2 diabetes ePublished: 6 September 2011 Issue Published: 6 September 2011 Copyright & PermissionsCopyright © 2011 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...