Guidelines Versus Guidelines: What's Best for the Patient?
Authors: Boris Draznin, David M. Nathan, Mary T. Korytkowski, Marie E. McDonnell, Sherita Hill Golden, Mark H. Schutta, William T. Cefalu
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions7 August 2018Guidelines Versus Guidelines: What's Best for the Patient?Correction(s) for this article:CorrectionsMay 2019Correction: Guidelines Versus Guidelines: What's Best for the Patient?FREEBoris Draznin, MD, PhD, David M. Nathan, MD, Mary T. Korytkowski, MD, Marie E. McDonnell, MD, Sherita Hill Golden, MD, MHS, Mark H. Schutta, MD, and William T. Cefalu, MDBoris Draznin, MD, PhDUniversity of Colorado Anschutz Medical Campus, Aurora, Colorado (B.D.), David M. Nathan, MDMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (D.M.N.), Mary T. Korytkowski, MDUniversity of Pittsburgh, Pittsburgh, Pennsylvania (M.T.K.), Marie E. McDonnell, MDBrigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (M.E.M.), Sherita Hill Golden, MD, MHSJohns Hopkins University School of Medicine, Baltimore, Maryland (S.H.G.), Mark H. Schutta, MDUniversity of Pennsylvania, Philadelphia, Pennsylvania (M.H.S.), and William T. Cefalu, MDAmerican Diabetes Association, Arlington, Virginia (W.T.C.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-0939 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Diabetes mellitus is a chronic disease that frequently leads to debilitating and life-threatening complications. Optimally managing type 2 diabetes entails avoiding acute metabolic complications and preventing long-term microvascular conditions (retinopathy, nephropathy) as well as neuropathic and macrovascular complications (cardiovascular and peripheral arterial disease) that reduce quality of life and longevity. Epidemiologic and landmark randomized clinical trials in both types of diabetes established the primacy of glycemia as a causal factor for microvascular complications (1, 2). The DCCT (Diabetes Control and Complications Trial) (1) and UKPDS (United Kingdom Prospective Diabetes Study) (2) in type 1 and type 2 diabetes, respectively, demonstrated ...References1. Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al; Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-86. [PMID: 8366922] CrossrefMedlineGoogle Scholar2. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352:837-53. [PMID: 9742976] CrossrefMedlineGoogle Scholar3. American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes-2018. Diabetes Care. 2018;41:S55-S64. 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[PMID: 18784090] doi:10.1056/NEJMoa0806470 CrossrefMedlineGoogle Scholar7. Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, Buse JB, et al; Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545-59. [PMID: 18539917] doi:10.1056/NEJMoa0802743 CrossrefMedlineGoogle Scholar8. Riddle MC, Ambrosius WT, Brillon DJ, Buse JB, Byington RP, Cohen RM, et al; Action to Control Cardiovascular Risk in Diabetes Investigators. Epidemiologic relationships between A1C and all-cause mortality during a median 3.4-year follow-up of glycemic treatment in the ACCORD trial. Diabetes Care. 2010;33:983-90. [PMID: 20427682] doi:10.2337/dc09-1278 CrossrefMedlineGoogle Scholar9. Bonds DE, Miller ME, Bergenstal RM, Buse JB, Byington RP, Cutler JA, et al. The association between symptomatic, severe hypoglycaemia and mortality in type 2 diabetes: retrospective epidemiological analysis of the ACCORD study. 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[PMID: 10938048] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Colorado Anschutz Medical Campus, Aurora, Colorado (B.D.)Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (D.M.N.)University of Pittsburgh, Pittsburgh, Pennsylvania (M.T.K.)Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (M.E.M.)Johns Hopkins University School of Medicine, Baltimore, Maryland (S.H.G.)University of Pennsylvania, Philadelphia, Pennsylvania (M.H.S.)American Diabetes Association, Arlington, Virginia (W.T.C.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0939.Corresponding Author: Boris Draznin, MD, PhD, 12801 East 17th Avenue, Aurora, CO 80045; e-mail, Boris.[email protected]edu.Current Author Addresses: Dr. Draznin: 12801 East 17th Avenue, Aurora, CO 80045.Dr. Nathan: 50 Staniford Street, Suite 340, Boston, MA 02114.Dr. Korytkowski: 3601 Fifth Avenue, Falk Building, Room 560, Pittsburgh, PA 15213.Dr. McDonnell: 75 Francis Street, Boston, MA 02115.Dr. Hill Golden: 1830 East Monument Street, Room 9052, Baltimore, MD 21287.Dr. Schutta: 3400 Civic Center Boulevard, Suite 4-900W, Philadelphia, PA 19104.Dr. Cefalu: 2451 Crystal Drive, Suite 900, Arlington, VA 22202.Author Contributions: Conception and design: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.Analysis and interpretation of the data: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.Drafting of the article: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.Critical revision for important intellectual content: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.Final approval of the article: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.Collection and assembly of data: B. Draznin, D.M. Nathan, M.T. Korytkowski, M.E. McDonnell, S. Hill Golden, M.H. Schutta, W.T. Cefalu.This article was published at Annals.org on 22 May 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoGuidelines Versus Guidelines Cait O'Sullivan , Aaron M. Tejani , and Thomas Finucane Guidelines Versus Guidelines Boris Draznin , David M. Nathan , Mary T. Korytkowski , Marie E. McDonnell , Sherita Hill Golden , Mark H. Schutta , and William T. Cefalu Correction: Guidelines Versus Guidelines: What's Best for the Patient? Metrics Cited byDigital diabetes: Perspectives for diabetes prevention, management and researchDelays in anti‐hyperglycaemic therapy initiation and intensification are associated with cardiovascular events, hospitalizations for heart failure and all‐cause mortalityCorrection: Guidelines Versus Guidelines: What's Best for the Patient?Guidelines Versus GuidelinesCait O'Sullivan, PharmD, Aaron M. Tejani, PharmD, and Thomas Finucane, MDThe Changing Definition of a Primary Care ProviderAnne L. Peters, MDBrief Commentary: Confusing Treatment Guidelines for Patients With Type 2 DiabetesIrl B. Hirsch, MD and Jay S. Skyler, MD 7 August 2018Volume 169, Issue 3Page: 186-187KeywordsCardiovascular diseasesHbA1cHemoglobinHypoglycemiaLife expectancyMyocardial infarctionPatient advocacyPopulation statisticsRetinopathyType 2 diabetes ePublished: 22 May 2018 Issue Published: 7 August 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...