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The Glycemic Explorer Challenge – Test Your Knowledge

What do you know about the guidelines for type 2 diabetes and how they’re being used in clinical practice

Even if you know the ADA and AACE guideline recommendations, you may be surprised to learn about the average time to actual therapy intensification.

Title: Guidelines in Theory and in Practice

Welcome to the Glycemic Explorer Challenge series! I’m Dr. Helen Baron your host—and a clinical and academic endocrinologist. I’ll be challenging you on your knowledge of the complexities in type 2 diabetes and treatment, and sharing with you how your answers compare with thousands of your peers who have taken the challenge at various national meetings and conferences.

Okay, let’s begin. As you know, guidelines from the American Diabetes Association and the Association of Clinical Endocrinologists are the standard for the management of type 2 diabetes. So how often do you think ADA and AACE guidelines recommend to titrate or add therapy if a patient’s A1c is not at goal?

I’ll give you a minute to think about your answer, and then we’ll see how your peers responded before we go over the correct answer.

Okay so here’s how your peers answered. The majority seemed to choose 3 months, although we can see that there were a few folks who answered 6 months or even greater than 9 months.

And those that chose 3 months are correct.

According to the ADA and AACE expert guidelines, patients with diabetes should be seen and evaluated every 3 months if their A1C is not at target. And then, once a patient’s individualized target is achieved, the ADA recommends maintaining therapy and checking A1c at least every 6 months after that. If a patient’s A1c is still not at goal, therapy should be titrated or added.

So, the guidelines and the community are aligned around titrating or adding therapy every three months when patients are not at goal. But let me challenge you with another question. In patients who weren’t at goal, how long did physicians wait to add insulin in actual clinical practice?

The data we looked at come from a clinical practice database analysis of patients uncontrolled on 3 OADs with A1c greater than or equal to 8%, which looked at how long physicians waited to add insulin.

Your choices are 3 months, 1 year, 3 years, or greater than 6 years.

I’ll give you a second to think about your answer.

Now let’s see how your peers responded.

Wow, they seemed to have had quite a mixed response.

Surprisingly, it took over 6 years to add insulin in actual clinical practice.

And here’s the study design.

So, as we can see from these two questions: Even though ADA guidelines say to intensify therapy every 3 months in patients who are not at goal, in actual clinical practice it can take as long as 6 years!

We know there are many potential barriers to achieving glycemic targets, including HCP-, patient-, and system-level barriers as well as discontinuity of care. However, according to the 2016 ADA Standards of Care, after adjusting for patient factors, the variation in quality of diabetes care across providers and practice settings indicates that there is potential for substantial system-level improvements.

It’s been shown that early and intensive intervention may improve current and future outcomes.

So, I’ll leave you with something to think about. In your uncontrolled patients, will your next move do enough?

Thanks for joining us. Look for more chances to challenge yourself with the other videos in this series.

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