In his presentation, James Gavin III, MD, describes why he thinks the current approach to diabetes treatment is failing.
A new approach in treating diabetes is needed that moves away from treatment to failure and towards a treatment to goal approach, said James Gavin III, MD, PhD,S in his presentation, “Treatment of Type 2 Diabetes 2010.”
Gavin is the CEO and chief medical officer, of Healing Our Village, Inc., and serves as clinical professor of medicine, at Emory University School of Medicine.
“The treat to failure approach has not served anyone well,” Gavin told the audience. Instead it is important to treat as early as possible and maintain goals.
Among Gavin’s recommendations were that the current guidelines for diabetes diagnosis should include measuring A1C scores. Gavin said the score is better standardized than glucose, is a better index of glucose exposure, and allows for less biologic variability.
The advantages to early intensive glucose control include research proven reductions in the development of diabetes, he said. When treatment therapies focus on getting patients to targeted A1C levels, reductions in complications have been proven, he said.
This is why the approach must be changed, Gavin said. Currently, physicians receive patients too late, and then they rely on lifestyle changes, he said. When drug treatments fail, they advance therapy. If instead, early combination therapy was used, the physicians and patients could advance at a pace that would keep patients at goal, he said.
Because beta cell function declines as diabetes progresses, looking at beta cell production as a function of glycemic control may be necessary, he said. Gavin highlighted research studies that suggested glitazones, such as rosiglitazone, preserve beta cell function.
It’s important to take advantage of tools that might help us with early diagnosis, he said. Part of the equation is saving beta cell functions. Gavin highlighted a study focusing on GLP-1 receptor agonists, which exhibited favorable effects on beta cell function. Focusing on obesity may be essential as well in normalizing glucose levels.
Gavin suggested the targets should include a goal of maintaining the A1C measurements at 7% or lower. More importantly, he said that physicians must try to generate the informed, empowered patient. To do so, a physician must promote the patient’s active self management and enhance the patient’s psychological care.