Redefining Diabetes Strategies in Primary Care: Four New Pillars of Management

Abstract

The management of Type 2 diabetes mellitus (T2DM) is possibly becoming one of the most challenging aspects of primary care. With millions of individuals worldwide living with T2DM, who are at a higher risk of developing multiple additional chronic conditions including cardiovascular disease (CVD) and renal disease, it is imperative that primary care practitioners (PCPs) around the world are comfortable with the management of T2DM. However, with dozens of T2DM medications available, many of which have associated risks of side effects such as hypoglycemia, the management of T2DM can be quite time-consuming for the busy family physician.
 In light of the above, it is important that we look at T2DM through a new lens. It is imperative that clinicians view the management of T2DM not just as “blood glucose management” but rather, that they adopt a person-centric, holistic management approach that takes into account the mitigation of microvascular and macrovascular complications, in order to reduce the morbidity and mortality associated with the condition. When it comes to the management of this condition, one needs to be less of a “glucologist” and more of a “diabetologist”. In order to develop this approach, with the busy PCP in mind, I suggest four pillars on which to focus during a T2DM appointment, that are beyond the laboratory HbA1c measurement.