October 28, 2009
The current system for managing diabetes has become problematic and increasingly outdated for many physicians, especially as newer diabetes drugs have come to market. Two medical groups, American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE), recently released a new algorithm to assist doctors to more accurately diagnose and treat diabetes. In the US, about 1 in 11 people have diabetes. For people living with HIV, the rate is about the same: about 1 in 10.
The new system takes into account the most recent clinical data from a few large studies and several drug approvals by the FDA. This dramatic shift in treating diabetes precipitated the need for a new assessment system, one that was designed to guide choosing the best treatments to lower a person's blood sugar level. For diabetics, a hemoglobin A1c value of 6.5% or lower is the standard tool for determining blood sugar control.
The main thrust of the new system is that for those starting with an A1c value of 7.5% or lower, one drug is recommended to get below 6.5%. For those with values from 7.6-9%, two drugs are recommended. For people with an A1c value above 9%, starting on three meds is recommended. Other recommendations are included for using insulin. Another chart is also available that details the risks and benefit of each drug.
However, the true mark of whether this new system actually does improve health outcomes would be to compare it to current standard therapy. That will involve more clinical study, and Project Inform hopes that any studies undertaken will also include people living with HIV. Although co-presented by them, this system is not an official AACE position, nor has it been approved by the American Medical Association or federal government as standard therapy.
Diabetes has become a concern for many in a growing, aging population of HIV-positive people. This new system presented by AACE/ACE will hopefully be a step forward in helping these individuals and their providers make sound treatment decisions based upon the latest understanding of diabetes and pave the way to healthier lives for HIV-positive individuals.
AACE/ACE stated that the algorithm "should be used in conjunction with more detailed clinical practice guidelines". Read the full Consensus Statement for more information as well as viewing the algorithm.