'Lending hand' model shows 5 necessary interventions for diabetes treatment
In a new editorial published in American Family Physician, a team of researchers outline why glycemic control should no longer be considered the primary intervention when it comes to diabetes management.
The "lending a hand" model outlined in the paper suggests there are five major forms of diabetes treatment, descending in importance from the thumb to the pinky: smoking cessation, blood pressure control, metformin therapy, lipid reduction and glucose control.
The illustration offers a simple way for physicians to communicate with patients about a treatment plan, and it also proposes that blood sugar control isn't the main thing to be worried about.
"Glycemic control is stuck in people's minds as the primary goal of treatment, but evidence has existed since the 1970s that other interventions are of greater benefit," said senior author Allen Shaughnessy, Pharm.D., M.Med.Ed., professor of family medicine at Tufts University School of Medicine and fellowship director of the Tufts University Family Medicine Residency Program at Cambridge Health Alliance.
Length and quality of life most important
The authors stress that there is a paradigm shift happening in diabetes treatment priorities. Interventions must focus on improving the length and quality of life, according to new guidelines from the American Diabetes Association and the European Association for the Study of Diabetes.
Adopting a new mindset about diabetes treatment may require shedding old ideas, the authors said, but there will be a better "return on investment" if doctors can learn to encourage other strategies along with blood sugar control.
"Working to control blood glucose while not addressing the other risk factors first is like rearranging deck chairs on the Titanic. The ship's going down," said author David Slawson, M.D., professor and vice chair of the department of family medicine, director of the Center for Information Mastery, and director of the family medicine fellowship at University of Virginia School of Medicine.
Photo credit: "hand-palm facing out" by johnny_automatic; modified by Heather White/Tufts University