Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement From the American Diabetes Association and the European Association for the Study of Diabetes
Response to Nathan et al.
- Paul S. Jellinger, MD, MACE1,
- Harold E. Lebovitz, MD, FACE2,
- Jaime A. Davidson, MD, FACE3 and
- on behalf of the ACE/AACE Outpatient Glycemic Control Implementation Task Force
- 1Department of Medicine, University of Miami, Miami, Florida
- 2Section of Endocrinology, Department of Medicine, State University of New York at Brooklyn, Brooklyn, New York
- 3Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, Texas
- Address correspondence to Paul S. Jellinger, MD, MACE, 1150 N. 35th Ave., Suite 590, Hollywood, FL 33021-5468. E-mail: pjellinger{at}diabetes-endocare.com
The recently published consensus treatment algorithm of the American Diabetes Association and the European Association for the Study of Diabetes (1,2) is an attempt to simplify the management of hyperglycemia in patients with type 2 diabetes. The goal, obviously, is to provide physicians with a tool that will allow them to attain the best outcomes for their patients. The guiding principles as outlined by the authors were cost, evidence-based clinical trials, and experience with long-term use. Although emphasizing the early initiation of pharmacologic therapy with metformin is a welcome strategy, several major features of the algorithm significantly limit its ability to achieve the best outcomes. Three such features are the therapeutic …
