Abstract
Aims
To develop consensus-based recommendations for the management of chronic complex patients
with type 2 diabetes mellitus using a two round Delphi technique.
Methods
Experts from the Diabetes and Obesity Working Group (DOWG) of the Spanish Society
of Internal Medicine (SEMI) reviewed MEDLINE, PubMed, SCOPUS and Cochrane Library
databases up to September 2014 to gather information on organization and health care
management, stratification of therapeutic targets and therapeutic approach for glucose
control in chronic complex patients with type 2 diabetes mellitus.
A list of 6 recommendations was created and rated by a panel of 75 experts from the
DOWG by email (first round) and by open discussion (second round). A written document
was produced and sent back to DOWG experts for clarification purposes.
Results
A high degree of consensus was achieved for all recommendations summarized as 1) there
is a need to redesign and test new health care programs for chronic complex patients
with type 2 diabetes mellitus; 2) therapeutic targets in patients with short life
expectancy should be individualized in accordance to their personal, clinical and
social characteristics; 3) patients with chronic complex conditions and type 2 diabetes
mellitus should be stratified by hypoglycemia risk; 4) age and specific comorbidities
should guide the objectives for glucose control; 5) the risk of hypoglycemia should
be a key factor when choosing a treatment; and 6) basal insulin analogs compared to
human insulin are cost-effective options.
Conclusion
The assessment and recommendations provided herein represent our best professional
judgment based on current data and clinical experience.
Abbreviations:
CCM (Chronic Care Model), CGW (Core Working Group), DOWG (Diabetes and Obesity Working Group), NPH (Neutral Protamine Hagedorn), SEMI (Spanish Society of Internal Medicine), T2DM (type 2 diabetes mellitus)Keywords
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Article info
Publication history
Published online: November 13, 2015
Accepted:
October 19,
2015
Received in revised form:
September 28,
2015
Received:
June 14,
2015
Identification
Copyright
© 2015 European Federation of Internal Medicine. Published by Elsevier Inc. All rights reserved.
