Personalized and prioritized diabetes treatment recommendations to reduce cardiovascular risk

Abstract

Widespread use of electronic medical records (EMRs) makes personalized assessments of the potential benefit of vari ous potential treatment decisions possible. Personalization can be carried out in at least three ways: personalized treatment goals based on age, comorbid conditions and risks of aggressive treatment; personalized treatment suggestions based on current treatment, comorbidities, allergies and other factors; and prioritization of multiple evidence-based treatment recommendations based on potential benefits to patients. How to quantify cardiovascular risk A recent study from Denmark that followed all diabetes patients in that nation over a 14 - year period of time recorded 47 cardiovascular (CV) deaths for every one renal death in diabetes patients [1]. Other data also demonstrate that the main cause of excess mortality and excess healthcare costs related to diabetes complications is major CV events, primarily myocardial infarction and stroke [2]. We have all seen the terrible toll that end-stage renal failure, amputations and blindness take on quality of life; but it is the CV complications of diabetes that end lives early and account for the lion’s share of lost years of life in those with diabetes. Thus, it is of great importance for clinicians who care for adult diabetes patients to carefully monitor and manage each patient’s CV risk (CVR). We have always done this in an intuitive way, but recent data indicate that intuitive assessments of CVR are often wrong. We overestimate risk for some patients, and seriously underestimate risk for other patients. A more