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ACE and AACE Issue Treat-to-Target Road Map

The American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) have produced new recommendations that offer guidance to practitioners trying to meet existing diabetes treatment guidelines.

According to ACE and AACE, clinicians and patients aren't doing enough to control type 2 diabetes.

In August 2001, an ACE/AACE panel issued treatment guidelines to stem the burgeoning epidemic of obesity and diabetes. In February of this year, the two groups met again to create a road map to show how to get there.

"Because type 2 diabetes is a very serious disease and has to be treated appropriately, this conference was designed to help health care professionals and patients achieve recommended goals," explains Lawrence Blonde, MD, of Ochsner Clinic. Blonde was part of the team that developed a consensus position statement about how best to implement the guidelines.

For example, noting that only one-third of people with diabetes reach target goals for glycated hemoglobin (A1C), Blonde says that more intensive efforts toward glycemic control are needed to reduce the devastating effects of diabetes.

The ACE/AACE position statement says early use of combination therapies, including pharmacologic agents (insulin and oral agents), medical nutrition therapy, and lifestyle interventions, is effective in achieving and maintaining glycemic targets. It recommends therapies be added when glycemia exceeds targets.

ACE and AACE recommend an A1C level of 6.5%, which is lower than the American Diabetes Association (ADA) target of 7%. "There appears to be no glycemic threshold for reduction of complications; the lower the A1C, the lower the rate," the position statement says.

The ACE/AACE and ADA recommendations "are more similar than they are different," Blonde says. "Everybody believes that the A1C level should be as close to the nondiabetic range as can be achieved."

The ACE/AACE recommendations for implementing target goals include:

• Early screening of at-risk patients, beginning at age 30, to prevent progression of impaired glucose tolerance to type 2 diabetes;
  
• Early, aggressive glycemic control in patients with diabetes, with an "uncompromising `treat-to-target'" approach;
  
• Patient-centered team care that includes greater diabetes education and advocating a chronic-care model;
  
• Frequent self-monitoring of blood glucose;
  
• Greater efforts to help patients follow meal plans;
  
• Daily exercise to help manage diabetes and its risk factors; and
  
• Medication as needed to help manage the condition.
  

Development of the implementation position statement involved experts from nine countries and representatives from the American Association of Diabetes Educators, the American Medical Society, and other professional groups. Blonde says the presentations from the consensus conference are being developed into papers that will be submitted to a major medical journal.

Footnotes

FYI

The position statement developed by an expert panel of the American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) can be found at http://www.aace.com/pub/odimplementation/index.php.

The American Diabetes Association (ADA) Clinical Practice Recommendations, Standards of Medical Care, can be found at http://care.diabetesjournals.org/cgi/content/full/28/suppl_1/s4.

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Goldfarb, B. Search for Related Content PubMed Articles by Goldfarb, B. Social Bookmarking                What's this?