The recent change in diabetic blood sugar goals is a huge win for personalized medicine.
For the past several years, patients with diabetes have been clumped into categories based on their diagnoses and assigned specific goal metrics as standards of care.
For example, any person with diabetes who hasn’t had heart disease should have a hemoglobin A1C lab value goal (3 months average of blood sugars) of less than 7. This led to over-treatment of many people, and unnecessary medication side effects for many.
In new guidelines published in the Annals of Internal Medicine, the American College of Physicians cites evidence that treating to targets of 7 percent or lower, rather than 8 percent, does not reduce the risk for death or macrovascular events—such as coronary artery disease, peripheral arterial disease, and stroke—over five to 10 years. It does, however, result in “substantial harms” such as hypoglycemia.
Essentially, this statement claims that people have been harmed by over-treatment due to rigorous diabetic quality measures.
The important questions are specific to the individual: Which patients would do better at a lower average blood sugar and which patients feel better and have fewer complications if we let their blood sugars be a little higher?
The answers may lie in medication choice, as well as a patient’s unique lifestyle factors such as genetics, environment, diet and exercise.
When we take the focus off the numbers or general guidelines that lump everyone in the same treatment path and look at each patient individually, we can deliver care that increases quality of life.
When we look to find and treat illnesses at their root cause, we use less medication, and thus have less potential for side effects or harmful treatments.
Treating illness at its root cause requires a personalized approach—including lifestyle and diet modification, and a partnership between health care providers and patients.