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An Evidence-Based Medicine Approach to Antihyperglycemic Therapy in Diabetes Mellitus to Overcome Overtreatment.

Abstract

Overtreatment is pervasive in medicine and leads to potential patient harms and excessive costs in health care. Although evidence-based medicine is often derided as practice by rote algorithmic medicine, the appropriate application of key evidence-based medicine principles in clinical decision making is fundamental to preventing overtreatment and promoting high-value, individualized patient-centered care. Specifically, this article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions. Here, we illustrate the application of these principles to considering the decision of whether or not to recommend intensive glycemic control to patients to minimize microvascular and cardiovascular complications in type 2 diabetes mellitus. Through this lens, this example will illustrate how an evidence-based medicine approach can be used to individualize glycemic goals and prevent overtreatment, and can serve as a template for applying evidence-based medicine to inform treatment decisions for other conditions to optimize health and individualize patient care.

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  • Authors+Show Affiliations

    ,

    From Division of General Internal Medicine, UT Southwestern Medical Center, Dallas (A.N.M., O.K.N.); and Division of Outcomes & Health Services Research, UT Southwestern Medical Center, Dallas (A.N.M., O.K.N.). anil.makam@utsouthwestern.edu.

    From Division of General Internal Medicine, UT Southwestern Medical Center, Dallas (A.N.M., O.K.N.); and Division of Outcomes & Health Services Research, UT Southwestern Medical Center, Dallas (A.N.M., O.K.N.).

    Source

    Circulation 135:2 2017 Jan 10 pg 180-195

    MeSH

    Decision Making
    Diabetes Mellitus
    Evidence-Based Medicine
    Humans
    Hypoglycemic Agents
    Patient Participation
    Patient-Centered Care

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    28069712

    Citation

    TY - JOUR T1 - An Evidence-Based Medicine Approach to Antihyperglycemic Therapy in Diabetes Mellitus to Overcome Overtreatment. AU - Makam,Anil N, AU - Nguyen,Oanh K, PY - 2017/1/11/entrez PY - 2017/1/11/pubmed PY - 2017/5/4/medline KW - clinical decision making KW - diabetes complications KW - diabetes mellitus KW - evidence-based medicine KW - medical overuse KW - review SP - 180 EP - 195 JF - Circulation JO - Circulation VL - 135 IS - 2 N2 - Overtreatment is pervasive in medicine and leads to potential patient harms and excessive costs in health care. Although evidence-based medicine is often derided as practice by rote algorithmic medicine, the appropriate application of key evidence-based medicine principles in clinical decision making is fundamental to preventing overtreatment and promoting high-value, individualized patient-centered care. Specifically, this article discusses the importance of (1) using absolute rather than relative estimates of benefits to inform treatment decisions; (2) considering the time horizon to benefit of treatments; (3) balancing potential harms and benefits; and (4) using shared decision making by physicians to incorporate the patient's values and preferences into treatment decisions. Here, we illustrate the application of these principles to considering the decision of whether or not to recommend intensive glycemic control to patients to minimize microvascular and cardiovascular complications in type 2 diabetes mellitus. Through this lens, this example will illustrate how an evidence-based medicine approach can be used to individualize glycemic goals and prevent overtreatment, and can serve as a template for applying evidence-based medicine to inform treatment decisions for other conditions to optimize health and individualize patient care. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/28069712/full_citation L2 - http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=28069712 ER -