Glycemic Control Targets Can Be More Flexible

Targets should be tailored to reflect individual patients' lifestyles and preferences

TUESDAY, April 21 (HealthDay News) -- Setting rigid glycemic control targets is of dubious benefit, and targets should be tailored to individual patients based on lifestyle and clinical factors, according to a study published online ahead of print April 21 in the Annals of Internal Medicine.

Victor M. Montori, M.D., of the Mayo Clinic Center for Translational Science Activities in Rochester, Minn., and Merce Fernandez-Balsells, M.D., of the Hospital Universitari de Girona Doctor Josep Trueta in Spain, conducted a review of clinical trials which randomized diabetes patients to either loose or tight glycemic control targets.

Rather than focusing on glycemic control, the priority should be promotion of a healthy lifestyle, preventive care, and risk reduction for cardiovascular disease, the investigators discovered. The evidence of the reviewed trials did not point to tight glycemic control being more beneficial than loose control; while patients grappling with comorbid conditions may find tight glycemic control interventions overwhelmingly difficult to achieve.

"Glycemic targets can be adjusted - up or down - according to the burden of treatment; side effects; and the patient's context, values, and preferences," the authors write. "Given that tighter control may be beneficial, some patients who are less concerned about downsides, and are ready to do whatever may possibly help, may choose tighter control. The need to set individual glycemic targets suggests that hemoglobin A1c targets for clinical use cannot be the same when used to measure quality of care."

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