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Personalised treatment targets in type 2 diabetes patients: The Dutch approach

  • Anne Meike Boels
    Correspondence
    Corresponding author at: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
    Affiliations
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
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  • Huberta E. Hart
    Affiliations
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands

    Leidsche Rijn Julius Health Centers, Eerste Oosterparklaan 78, 3544 AK Utrecht, The Netherlands
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  • Guy E. Rutten
    Affiliations
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
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  • Rimke C. Vos
    Affiliations
    Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
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Published:September 13, 2016DOI:https://doi.org/10.1016/j.pcd.2016.08.001

      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.

      Keywords

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