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Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online Oct. 23 in the Annals of Internal Medicine. Paul R. Conlin, M.D., from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes mellitus. The authors provided updates on management within seven areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of hemoglobin A1c (HbA1c), individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice," the authors write.

For young patients with type 1 diabetes, insulin pump therapy is associated with lower risks of severe hypoglycemia and diabetic ketoacidosis and better glycemic control than insulin injection therapy, according to a study published online Oct. 10 in the Journal of the American Medical Association. Beate Karges, M.D., from RWTH Aachen University in Germany, and colleagues conducted a population-based cohort study in 446 diabetes centers. They identified patients with type 1 diabetes who were younger than 20 years and had diabetes duration of more than one year. The researchers found that 14,119 patients used pump therapy and 16,460 used insulin injections. A total of 9,814 patients using pump therapy were matched with 9,814 using injection therapy. Compared with injection therapy, pump therapy was correlated with lower rates of severe hypoglycemia (9.55 versus 13.97 per 100 patient-years) and diabetic ketoacidosis (3.64 versus 4.26 per 100 patient-years). Lower levels of glycated hemoglobin were seen with pump versus injection therapy (8.04 versus 8.22 percent). Compared with injection therapy, pump therapy was associated with lower total daily insulin doses (0.84 versus 0.98 U/kg). No significant difference in body mass index was seen between the treatment regimens