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I think we can also appreciate that how we balance and weigh up all these different factors I’ve been listing for you may be strongly related to our personal interpretation. So, it’s very easy to move from a patient-centred approach to a doctor-centred approach. And I’m going to give you an example of that. Now, in collaboration with a friend of mine, Dr Itamar Raz in Tel Aviv, we designed six vignettes, to represent different cases of type 2 diabetes. And then we sent these vignettes to 244 key worldwide opinion-leading diabetologists. So, you have to bear in mind that these are all the top people, those who are convening, racking up consensus guidelines and so on. So, we had 151 top diabetologists from all around the world, responding to two surveys. The first one asked them to rank 11 parameters affecting patient HbA1c target selection. So, in other words, we asked what is the most important parameter to consider when you identify the individualised glycaemic target. And the second one, as I already mentioned to you, was to define the HbA1c target for six clinical cases that we had provided them with. Now, let me give you an example of what emerged from this survey and please remember, these are the top and most expert diabetologists you could think of.
  • 6 vignettes for different cases of type 2 diabetes were developed
  • 244 key worldwide opinion-leading diabetologists were contacted
  • 151 responded to two surveys and were asked to:
    • Rank 11 parameters affecting the patient’s HbA1c target selection
      (1 being the most important, 11 being the least important)
    • Define the HbA1c target for six clinical cases ranging from newly diagnosed diabetes with no evidence of complications to a frail, elderly patient with multiple complications and/or comorbidities

Cahn A, Raz I, Kleinman Y, Balicer R, Hoshen M, Lieberman N, Brenig N, Del Prato S, Cefalu WT. Clinical Assessment of Individualized Glycemic Goals in Patients With Type 2 Diabetes: Formulation of an Algorithm Based on a Survey Among Leading Worldwide Diabetologists. Diabetes Care. 2015 Dec;38(12):2293-300.
http://www.ncbi.nlm.nih.gov/pubmed/26519337