Comparing glycemic control guidelines in diabetes care

Background:Diabetes mellitus (DM) is reaching epidemic proportions nationally and globally. DM complications—such as cardiovascular disease, stroke, renal failure, amputations, diabetic neuropathy, and blindness—exert substantial emotional, physical, and financial tolls on the individual, as well as reduce workforce productivity.Objective:The goal of this article was to examine guidelines for glycemic control in DM from three national organizations and consider the reasons for their similarities and differences.Methods:The National Guideline Clearinghouse was initially searched for the list of guidelines related to DM. The most recent, relevant guidelines from three national organizations (the American Diabetes Association [ADA], the American College of Endocrinology [ACE], which is affiliated with the American Association of Clinical Endocrinologists, and the Veterans Health Administration/Department of Defense [VA/DoD]) were selected and then accessed through journals or the organizations' Web sites. The bibliographies of the three guidelines were reviewed, and all studies relevant to the effect of glycemic control on diabetic complications were examined. A search of PubMed was also conducted (January 2000–July 2005) using the search terms diabetes, quality of care, VA, and US to assess the effect of the guidelines on clinical practice during the last decade.Results:Two landmark, randomized controlled studies and several smaller trials in the last decade have high-lighted the importance of tight glycemic control in reducing the incidence and progression of DM complications. Health care organizations may serve as liaisons between researchers and providers by developing specific recommendations and performance measures or goals for DM care, based on critical examination of the study results. Three national organizations—the ADA, the ACE, and the VA/DoD—periodically review DM research findings and expert opinions, and formulate clinical practice guidelines. Although all three organizations advocate tight glycemic control to prevent DM complications, they differ slightly in their chosen glycemic targets and their advice about applying these goals to all patient populations with this disease.Conclusions:All three organizations are takng the initiative to disseminate their guidelines for DM care to providers and patients. Clinicians and health care organizations are strongly encouraged to incorporate these guidelines into daily clinical practice and to assess their impact on patient care through continuous quality-of-care monitoring and provider recognition programs.