To what extent is the new position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) ‘personalised’?

Excerpt

To the Editor: The joint position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) on the management of hyperglycaemia in type 2 diabetes [1] not only constitutes a revision of the previous algorithm [2], but also a paradigm shift in the concept of diabetes care: the aspect repeatedly emphasised in this document is ‘patient-centred care’. The new ADA/EASD position statement is certainly innovative compared with its predecessor, because it includes many other therapeutic options based on patient-centred care with respect to sulfonylureas and basal insulin, when treatment with metformin alone has not achieved the therapeutic target [2]. The new algorithm takes into consideration the need for personalised treatment, and provides a series of recommendations about possible choices, highlighting the advantages and limitations of each therapeutic option. In this sense, the document appears to fail in its purpose, by focusing—as do all guidelines available to date—on a lengthy though highly detailed list of the possible therapeutic choices. Even though the authors define the new recommendations as being less prescriptive and not as ‘algorithm-like’ as its forerunners, it is still up to the physician to choose the most appropriate therapy for the patient. It seems likely that the authors thought of proposing different algorithms based on various aspects that vary over time (apart from those proposed to avoid weight gain, minimise cost and avoid hypoglycaemia), but realised that these would be highly complicated. An effective way of overcoming this problem would be to use an online interactive resource, as recently proposed with the algorithms relating to tailoring drug therapy for patients with type 2 diabetes issued by the Finnish Medical Society [3]. This computerised system allows people to quickly find subjects of interest according to their own particular clinical features, as well as to follow easy, step-by-step suggestions for additional therapeutic pathways. …