Evidence-Based Medicine Optimal for Diabetes Treatment

Some patients may not benefit from strict blood sugar control.

The use of evidence-based medicine (EBM) instead of a one-size-fits-all approach may prevent the overtreatment of patients with type 2 diabetes, according to a new study published by Circulation. This approach places an emphasis on individualized care to prevent overtreatment, since each patient has a different set of needs.

The National Academy of Medicine reported that 20% of $750 billion in wasteful healthcare spending is linked to overuse of care, meaning that overtreatment is largely involved with avoidable spending. Avoidable, wasteful spending drives up out-of-pocket costs, and places a financial burden on the healthcare system.

While numerous factors impact overuse, the study authors state that EBM could avoid this phenomenon. EBM is focused on weighing the benefits and the harms of treatment with a physician’s judgement, and a patient’s values and preferences, according to the study.

The investigators hope that this review can show physicians, educators, researchers, and policymakers how to use this approach to individualize treatment, improve patient outcomes, and reduce costs.

"Evidence-based medicine is a powerful tool to provide person-centered care to individuals with type 2 diabetes, as well as for patients with other diseases," said lead author Anil Makam, MD. "When applied to type 2 diabetes, EBM calls for a paradigm shift in our treatment approach."

The investigators propose avoiding intensive blood-sugar treatment as a blanket goal for all patients with type 2 diabetes, according to the study. While controlling blood glucose levels is optimal, intensive restrictions can lead to diminished quality-of-life and harm in certain patients.

Current guidelines suggest that patients with type 2 diabetes keep hemoglobin A1c levels under 7%, but this strategy offers small benefits, and may harm the patient, according to the study.

It also takes 2 decades for strict blood sugar control to achieve clinically meaningful results, the authors wrote. The investigators said that many older, frail adults can be successfully treated by aiming for more modest goals.

For example, elderly patients may benefit from A1c levels of 8.5% to 9% rather than 7%, which may be difficult to obtain. This method may allow patients to avoid harm, but benefit from treatment, according to the study.

By implementing an EBM approach, physicians may be able to improve patient health, while reducing overall medical costs, and managing diabetes. This may be also be a useful approach to reduce Medicare costs, since many elderly patients have type 2 diabetes.

However, each individual patient’s needs should be assessed before implementing a treatment regimen, since they may benefit from a different approach, compared with another patient.

"EBM is often misunderstood as a call for universal, cookie-cutter medicine, which has led to an epidemic of overtreatment in type 2 diabetes," concluded senior study author Oanh Nguyen, MD. "Instead, EBM is a critical tool in the physician's arsenal to provide individualized and person-centered care."