FP Report -- May 1999
FP perspective focuses guidelines on improving patient outcomes
Research shows that lowering glucose concentration to as close to normal as possible reduces the risk of complications in patients with diabetes. Does that mean you should aggressively strive to lower the glucose levels of all your diabetic patients?
"FPs get bombarded with half a zillion guidelines, and most of them come from people with questionable perspectives, if not questionable motives."
-- William Phillips, M.D.
A new clinical practice guideline in development by the AAFP and the American Diabetes Association will provide an up-to-date review of evidence and recommendations on the balance between harms and benefits of tight glycemic control in patients with type 2 diabetes mellitus. The draft guideline concludes that all patients benefit to some degree from glycemic control depending on their individual risk profiles.
William Phillips, M.D., a practicing family physician in Seattle and a member of the AAFP's Commission on Clinical Policies and Research, said the guideline will offer practical advice.
"There have been other guidelines and many studies over the years that tried to dictate the care of our patients, and many of them went far beyond the available evidence to make recommendations that were nearly impossible to implement in real-world practice," Phillips said. "This guideline will maintain a reasonable perspective while bringing us up to date on the best evidence."
Resources
- Be among the first to receive the new diabetes guideline, The Benefits and Risks of Controlling Blood Glucose Levels in Patients with Type 2 Diabetes Mellitus, by calling the AAFP at (800) 944-0000. The guideline (item #R928) is free with a $3 shipping and handling charge and should be released this summer.
- The AAFP Clinical Policy Review Form can help you evaluate clinical guidelines to determine whether a guideline is evidence-based and relevant to your practice. Get it at the AAFP Web site at http://www.aafp.org/clinical/polreview or order it from AAFP Express.
- If you're looking for a particular guideline, want to compare recommendations from various guidelines or need advice on a specific disease, check out http://www.guideline.gov for a guideline clearinghouse maintained by the Agency for Health Care Policy and Research.
The guideline reflects a trend of collaboration between the Academy and other organizations committed to distributing evidence-based clinical guidelines.
"The approach that the Academy has championed for a decade has become the norm, so now we can participate with others on developing guidelines, which is a refreshing change," said Herbert Young, M.D., AAFP Scientific Activities Division director.
Young noted that the Academy also has taken the lead in suggesting topics and helping to shape evidence reports with the Agency for Health Care Policy and Research. Those evidence reports will serve as springboards for future clinical guidelines. Family physicians representing the Academy have been involved in developing evidence reports on topics such as new onset of atrial fibrillation in the elderly, acne, attention deficit/hyperactivity disorder, cancer pain, pre-term labor, depression and acute bacterial rhinosinusitis.
Phillips said the AAFP's involvement lends credibility to a guideline. "FPs get bombarded with half a zillion guidelines, and most of them come from people with questionable perspectives, if not questionable motives," he said. "It's good to know that a guideline has been influenced by the Academy -- it speaks to its relevance."
Family physicians working on guidelines want to improve patient care through an evidence-based approach to treatment and prevention, said Phillips. Although guidelines can be an important tool in achieving that goal, they aren't always developed by other organizations with such a purpose in mind.
"The involvement of family physicians in the guidelines process helps maintain perspective on patient needs and relevant outcomes," said Phillips. "Instead of allowing subspecialists to dictate what they think we should do, which is mostly refer patients to them, an appropriate guideline can help family doctors use the best current medical evidence to improve the care of patients with the conditions we treat. We've got so much data -- and so little of it addresses the bottom-line concerns of our patients -- that you need an expert at the table to ask the right questions and insist on the appropriate answers. It turns out that expert is often the family doctor."
By Sharon Dickinson Dent, associate editor
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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