- HbA1c個別化目標
- 当初目的は７％-8%の間
- 6.5%未満なら薬物治療軽減を検討
- 高齢者（推定余命10年未満）・ナーシングホーム居住者・慢性疾患（認知症、担がん、終末期腎疾患、重症COPD/うっ血性心不全）への症状軽減目標で、HbA1ｃターゲット治療回避
Hemoglobin A1c Targets for Glycemic Control With Pharmacologic Therapy for Nonpregnant Adults With Type 2 Diabetes Mellitus: A Guidance Statement Update From the American College of Physicians
Ann. Int. Med. Mar. 6
http://annals.org/aim/fullarticle/2674121/hemoglobin-1c-targets-glycemic-control-pharmacologic-therapy-nonpregnant-adults-type
Guidance Statement 1: Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care.
Guidance Statement 2: Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes.
Guidance Statement 3: Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5%.
Guidance Statement 4: Clinicians should treat patients with type 2 diabetes to minimize symptoms related to hyperglycemia and avoid targeting an HbA1c level in patients with a life expectancy less than 10 years due to advanced age (80 years or older), residence in a nursing home, or chronic conditions (such as dementia, cancer, end-stage kidney disease, or severe chronic obstructive pulmonary disease or congestive heart failure) because the harms outweigh the benefits in this population.
AGREEII日本語訳
http://minds4.jcqhc.or.jp/minds/guideline/pdf/AGREE2jpn.pdf
大規模研究でもない”Kumamoto Study”への恣意的加重評価による“Kumamoto"宣言よりは意図的でない手法と思う・・・
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