Cahn Avivit, Raz Itamar, Kleinman Yosef, Balicer Ran, Hoshen Moshe, Lieberman Nicky, Brenig Naomi, Del Prato Stefano, Cefalu William T
Diabetes Research Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Diabetes Research Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Diabetes Care. 2015 Dec;38(12):2293-300. doi: 10.2337/dc15-0187. Epub 2015 Oct 30.
Observations over the past few years have demonstrated the need to adjust glycemic targets based on parameters pertaining to individual patient characteristics and comorbidities. However, the weight and value given to each parameter will clearly vary depending on the experience of the provider, the characteristics of the patient, and the specific clinical situation.
To determine if there is current consensus on a global level with regard to identifying these parameters and their relative importance, we conducted a survey among 244 key worldwide opinion-leading diabetologists. Initially, the physicians were to rank the factors they take into consideration when setting their patients' glycemic target according to their relative importance. Subsequently, six clinical vignettes were presented, and the experts were requested to suggest an appropriate glycemic target. The survey results were used to formulate an algorithm according to which an estimate of the patient's glycemic target based on individualized parameters can be computed. Three additional clinical cases were submitted to a new set of experts for validation of the algorithm.
A total of 151 (61.9%) experts responded to the survey. The parameters "life expectancy" and "risk of hypoglycemia from treatment" were considered to be the most important. "Resources" and "disease duration" ranked the lowest. An algorithm was constructed based on survey results. It was validated by presenting three new cases to 57 leading diabetologists who suggested glycemic targets that were similar to those calculated by the algorithm.
The resultant suggested algorithm is an additional decision-making tool offered to the clinician to supplement clinical decision making when considering a glycemic target for the individual patient with diabetes.
过去几年的观察表明，有必要根据个体患者特征和合并症相关参数调整血糖目标。然而，每个参数的权重和价值显然会因医疗服务提供者的经验、患者的特征以及具体临床情况而有所不同。
为了确定在全球范围内对于识别这些参数及其相对重要性是否存在当前共识，我们对全球244位主要的意见引领型糖尿病专家进行了一项调查。最初，医生们要根据相对重要性对他们在为患者设定血糖目标时考虑的因素进行排序。随后，展示了六个临床病例 vignettes ，并要求专家们提出合适的血糖目标。调查结果被用于制定一种算法，据此可以根据个体化参数计算患者血糖目标的估计值。另外三个临床病例被提交给一组新的专家以验证该算法。
共有151位（61.9%）专家回复了调查。“预期寿命”和“治疗导致低血糖的风险”参数被认为是最重要的。“资源”和“疾病持续时间”排名最低。根据调查结果构建了一种算法。通过向57位主要糖尿病专家展示三个新病例进行验证，他们建议的血糖目标与算法计算出的目标相似。
所得出的建议算法是为临床医生提供的一种额外决策工具，用于在为个体糖尿病患者考虑血糖目标时补充临床决策。
