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Glycemic Control in Type 2 Diabetes: Time for an Evidence-Based About-Face?
- Victor M. Montori, MD, MSc; and
- Mercè Fernández-Balsells, MD
- From the Mayo Clinic, Rochester, Minnesota, and Hospital Universitari de Girona Doctor J. Trueta, Girona, Spain.
Abstract
Some diabetes guidelines set low glycemic control goals for patients with type 2 diabetes mellitus (such as a hemoglobin A1c level as low as 6.5% to 7.0%) to avoid or delay complications. Our review and critique of recent large randomized trials in patients with type 2 diabetes suggest that tight glycemic control burdens patients with complex treatment programs, hypoglycemia, weight gain, and costs and offers uncertain benefits in return. We believe clinicians should prioritize supporting well-being and healthy lifestyles, preventive care, and cardiovascular risk reduction in these patients. Glycemic control efforts should individualize hemoglobin A1c targets so that those targets and the actions necessary to achieve them reflect patients' personal and clinical context and their informed values and preferences.
Article and Author Information
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Grant Support: The American Diabetes Association awarded Dr. Montori a Clinician Investigator grant in 2004. Novo Nordisk, a maker of insulin, subvented the American Diabetes Association granting program but did not have direct contact with the investigators and did not play any role in the awarding of the grant to the research team. Dr. Fernández-Balsells has received grant support from the Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo (BA08/90035), Government of Spain.
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Potential Financial Conflicts of Interest: Grants received: V.M. Montori (American Diabetes Association), M. Fernández-Balsells (Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo, Government of Spain). Dr. Montori's research group does not take funding from pharmaceutical or medical device corporations.
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Requests for Single Reprints: Victor M. Montori, MD, MSc, Knowledge and Encounter Research Unit, Mayo Clinic, Plummer 3-35, 200 First Street SW, Rochester, MN 55905; e-mail, kerunit{at}mayo.edu.
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Current Author Addresses: Dr. Montori: Knowledge and Encounter Research Unit, Mayo CTSA, Plummer 3-35, 200 First Street SW, Rochester, MN 55905.
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Dr. Fernández-Balsells: Servei d'Endocrinologia, Hospital Universitari de Girona Doctor J. Trueta, Carretera de França s/n, 17007 Girona, Spain.
