0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Changing the Diabetes Treatment Paradigm

Ronald Hirsch, MD
Arch Intern Med. 2009;169(13):1241-1247. doi:10.1001/archinternmed.2009.185.
Text Size: A A A
Published online

Extract

As an internist with a busy office practice and a large number of patients with type 2 diabetes mellitus, I was flabbergasted to read the Commentary by Havas1 on the lack of evidence supporting pharmacologic control of blood glucose levels and his recommendation that metformin be the sole oral agent used. Achieving a hemoglobin A1c (HbA1c) level below 7.0% is considered the sole measure of adequate diabetic control, and failure to achieve that mark is considered failure to adequately care for the patient. In fact, Medicare has included HbA1c control as one of its core measures for diabetes care in the recently enacted Physician Quality Reporting Initiative.2 Patients are routinely treated with multiple oral agents at a great expense, which only increases when we add injectable agents to the mix to achieve that elusive goal of an HbA1c level less than 7.0%. They endure adverse effects like nausea and diarrhea, which we pass off as nuisances, and risk hypoglycemia, which could have catastrophic effects. When we suspect that patients are not adherent with their prescribed treatment regimen and have an HbA1c above 7.0%, we consider discharging them from our practices so our data do not look bad. And yet Dr Havas now advocates controlling blood glucose for only the most extreme cases and concentrating our efforts on blood pressure and cholesterol control.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com
brightcove.createExperiences();