Personalised treatment targets in type 2 diabetes patients: The Dutch approach. Issue 1 (February 2017)

• Record Type: Journal Article
• Authors: Boels, Anne Meike; Hart, Huberta E.; Rutten, Guy E.; Vos, Rimke C.
• Is Part Of: Primary care diabetes. Volume 11:Issue 1(2017)
• Page Start: 71
• Page End: 77
• Publication Date: 2017-02
• Subjects: Type 2 diabetes mellitus -- Personalised medicine -- Individualised medicine -- Practice guidelines -- Treatment targets -- Patient-centred care -- Performance measures; Diabetes -- Periodicals; 616.462
• DOI: 10.1016/j.pcd.2016.08.001
• Languages: English
• ISSNs: 1751-9918

Abstract

Highlights: A personalised approach for treatment targets in type 2 diabetes is proposed. Personalising diabetes treatment targets should be simple and practical. Our approach could lead to more cardiometabolic well-controlled patients. Older patients and in those with polypharmacy could benefit most. Abstract: Aims: To compare the proportion of cardiometabolic well-controlled type 2 diabetes mellitus (T2DM) patients according to a clearly defined, simple personalised approach, versus the 'one-size-fits-all' approach. Methods: Observational study using routine data of primary care type 2 diabetes patients in the Netherlands. The proportions of patients that reach the targets for HbA1c, systolic blood pressure and low-density lipoprotein cholesterol in the two different approaches were compared. Results: Of the 890 patients (54.7% men, mean age 62.7 years), 31.8% were well-controlled according to the individualised approach and 24.8% according to the 'one-size-fits-all' approach. For specific subgroups personalising the treatment led to a 5.2%, 27.3% and 45.6% increase of patients achieving low-density lipoprotein cholesterol, HbA1c and systolic blood pressure goals respectively. Conclusions: A clearly defined and relatively simple personalised approach leads to a higher proportion of T2DM patients considered as cardiometabolic well-controlled. This approach may especially be beneficial for patients aged ≥70 years on more than metformin monotherapy (HbA1c) and for patients aged ≥80 years (SBP). Precisely these patients are suggested not to benefit from stricter HbA1c or SBP targets, whereas they may experience more adverse effects (e.g. hypoglycaemia, postural hypotension) when a stricter target value is pursued.