New Hyperglycemia Management Guidelines

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After doing much reading and trying tofollow what is said in the document released April 19, 2012 as thenew hyperglycemia management guidelines, I am beginning to understandwhat is being said. The guidelines were published in DiabetesCare by the American Diabetes Association (ADA) and inDiabetologia by the European Association for the Study ofDiabetes (EASD).
The last guidelines on management ofhyperglycemia were published about five years ago and recentdevelopments have now been incorporated into the new guidelines. Theclaim is made that there is growing complexity and some controversyin contemporary glycemic management for persons with type 2 diabetes– you think? What I do not understand is the thinking that oralmedication is the route to follow by adding medication aftermedication to solve the problem.
According the experts, the answer hasto follow the ACCORD rules and this is what pulled the study down. Medication on top of medication just does not work, but our diabetesexperts think this is the only way and Big Pharma has them convincedthat this is the route to go. This violates other statements andbasically means things will be business as usual.
Oh, yes, the guidelines are full ofplatitudes to make us think that the new guidelines are patientoriented, but when the president of ADA's medicine and science statesthat the ADA set the HbA1c goal at 7% in general, but with someindividualization, this means little or no change. At least otherbloggers are thinking that little will change and that doctors willcontinue to push oral medication after oral medication until it istoo late for insulin to prevent complications.
When the president for medicine andscience of the American Diabetes Association, Vivian Fonseca, MD, ofTulane University in New Orleans criticizes a study, you know thatthe ADA has something to protect in the new guidelines. This is one ofmedication combinations – in fact the medication combinationpromoted in the chart so highly prized by the ADA.
I agree with Tom Ross when he states. “What's new in these guidelines, apparently, is the emphasis onfiguring out which drug combination is right for different kinds ofpatients, on the basis of many different factors which can limit theefficacy or safety of particular drugs in particular individuals. Idon't think this is the revolution in thinking about diabetes carethat I would have liked to see.”
Everything about the new guidelinesseems prefaced on getting patients on medications and as soon aspossible. There seems no room for patients that want to managediabetes with diet and exercise; and there are many doing just thatand succeeding.
The other point that really upsets me –if they are really advocating individuals and allowing individualchoices, why is insulin listed last? This is just a continuation ofthe mantra of making this the medication of last resort whencomplications have already made themselves known. I really need towonder if people that desire to move to insulin will be allowed thechoice, or will the doctors want to keep piling oral medications onand generating more and more severe side effects. The side effectsof insulin are minor in comparison to some of the oral diabetesmedications. What are these so-called experts thinking? They mustbe followers of the insulin myths.