Table 3

Implementation of the algorithm

Risk of hypoglycemia from treatmentLife expectancyComorbiditiesMacrovascular complicationsDisease durationRecommended glycemic target by algorithmExpert's opinion, median (IQR)Results of repeat survey, median (IQR)
Original cases
 #2: A 70-year-old nursing home resident. Has moderate dementia and is currently treated with basal insulin.323328.1 (7.7–8.2)8.0 (7.8–8.0)8.0 (8.0–8.5)
 #3: An 80-year-old lawyer recently diagnosed with diabetes. Suffers from ischemic heart disease but does not have congestive heart failure. Is not taking any antidiabetes drugs at the moment and is eager to treat his condition. No evidence of microvascular complications.122217.1 (7.0–7.4)7.0 (7.0–7.5)7.5 (7.0–7.5)
 #4: An 87-year-old man has long-standing diabetes, mild dementia, and micro- and macrovascular complications. Is moderately compliant with current basal-bolus insulin regimen.333338.5 (8.0–8.5)8 (7.5–8.0)
 #5: A 45-year-old teacher has just been diagnosed with diabetes. No complications and not taking any antidiabetes medication. Has resources and is willing to take care of herself.111116.5 (6.5–7.0)6.5 (6.5–7.0)6.5 (6.5–7)
New cases
 #1: A 47-year-old diagnosed with type 2 diabetes 4 years ago. Not suffering from any diabetes complications. BMI 32.5 kg/m2. Currently treated with metformin and a DPP-4 inhibitor and moderately compliant.111116.6 (6.5–7.0)6.5 (6.5–6.8)
 #2: A 75-year-old was diagnosed with diabetes 10 years ago. Has stable IHD; PTCA 10 years ago and has well-controlled hypertension and hyperlipidemia. No evidence of microvascular complications. Antidiabetes medications include metformin and glimepiride (4 mg b.i.d.).222227.4 (7.3–7.7)7.5 (7.0–7.5)
 #3: A 67-year-old man diagnosed with diabetes >20 years ago. Is an active smoker and suffers from IHD and CHF NYHA IV, S/P CABG 12 years ago, and 2 PTCAs in the last 3 years. Microvascular complications include diabetic foot and macroalbuminuria. Has severe CRF. Antidiabetes medications include DPP-4 inhibitor, bedtime insulin, and injection of short-acting insulin for lunch. Noncompliant.333338.3 (8.0–8.5)8.0 (7.5–8.0)
  • Implementation of the algorithm in the clinical cases. The algorithm's output is calculated according to the eight-parameter algorithm, and the range is calculated using five parameters as described in the text. CABG, coronary artery bypass graft; CHF, congestive heart failure; CRF, chronic renal failure; DPP-4, dipeptidyl peptidase-4; IHD, ischemic heart disease; NYHA IV, New York Heart Association stage 4; PTCA, percutaneous transluminal coronary angioplasty.