February, 2009

Introducing the PHS/PCHI Clinical Guidelines Update for the Treatment of Type 2 Diabetes in the Non-Pregnant Adult

In the last two years, since the last set of diabetes guidelines from PHS/PCHI, there has been a lot of progress – much of which has made it more complicated to deliver the very best care. The obvious examples are the ACCORD and ADVANCE trials that were published this spring, showing potentially adverse consequences from the pursuit of very tight control in some patient subsets. But there have been plenty of other advances besides these studies that could and should influence everyday diabetes care.

Fortunately for me and other PCHI physicians, we have access to team of community and academic physicians, including a variety of specialists, who have reviewed all of the most recent literature and have updated the guidelines for our everyday use. There are so many issues that come up for all of us in the management of our diabetic patients -- we need to manage blood glucose with a growing number of medications available to us, and we need to manage blood pressure, lipids, and pay attention to preventative measures. I really appreciate that all of these topics and then some are right here at my fingertips and, thanks to this update, I can be confident that I am basing my decisions on the most current information available to us.

I anticipate the updated guidelines to be even more useful than the original thanks to newly added FAQ’s that have been answered by specialists throughout Partners. Also attached is a list of diabetes teaching groups throughout our network who are here to help us.

Please keep in mind that each patient is unique and may not fit within the recommended guidelines. Using your good clinical judgment is still number one, however we think the guidelines will be useful when you are adjusting medications, ordering labs, starting patients on insulin, and managing other aspects of patient care.

Please bookmark the Virtual Diabetes Center http://vdc.partners.org for electronic access to these guidelines. I hope you will visit the site often when you see patients with diabetes.

Best,

Thomas H. Lee, M.D.
CEO, Partners Community HealthCare, Inc.