VA, DoD Issue Type 2 Diabetes Clinical Practice Guideline


According to a recent clinical practice guideline, the management of type 2 diabetes should include shared decision-making, individualized diabetes self-management education, and individualized glycemic management plans.

The new clinical guidelines were published in Annals of Internal Medicine (online October 24, 2017; doi:10.7326/M17-1362).

A group of researchers led by Paul R Conlin, MD, Veterans Affairs (VA) Boston Healthcare System (West Roxbury, MA), convened a joint US Department of VA and US Department of Defense (DoD) Evidence-Based Practice Work Group (April 2017) in an effort to create a guideline for the management of type 2 diabetes. The working group was comprised of multidisciplinary practicing stakeholders and submitted to the Institute of Medicine’s tenets for trustworthy clinical practice guidelines.

Authors of the guideline agreed upon updates in management of type 2 diabetes in seven areas: patient-centered care and shared decision-making, glycemic biomarkers, target ranges of HbA1c, individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patient in the hospital. Key recommendations in the guideline include patients should be offered individualized diabetes self-management education, individualized glycemic management plans, and individualized target ranges for HbA1c.


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"In summary, the VA/DoD clinical practice guideline attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events,” authors of the guideline wrote. “Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision-making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice."

To read the full clinical practice guideline, click here.—Zachary Bessette