Individualizing Glycemia Control in Canadians to Meet Guideline Recommendations
People living with diabetes may not all meet their individual targets for their blood sugar levels according to a study published in BMJ Open Diabetes Research and Care journal featuring researchers at the University of Toronto’s Department of Family and Community Medicine.
The study showed that young people living with diabetes were more likely to have poor to moderately controlled blood sugar rather than tightly controlled levels. Younger people benefit from tighter glycemic control as it may prevent strokes or heart attacks years down the road. Alternatively, older people may be more at risk of complications due to low sugar. They are already on several medications and additional treatment for glycemia may not be of benefit to them. The Canadian Diabetes Association’s most recent guidelines emphasized the need for individual glycemic goals for patients which account for their physical circumstance, health goals and values.
“We, as physicians, should be working with our younger people to help them manage their glycemic levels,” says Dr. Michelle Greiver, a Clinician Scientist at Department of Family and Community Medicine, UTOPIAN’s Deputy Director, Scientist at North York General Hospital and co-lead for the study. “If you want to prevent blindness in 10 years, it is best to start by encouraging younger people to achieve tighter controls as they will live many more years with their condition.”
Good control of blood sugar reduces the onset of kidney disease and blindness at later stages of life and can potentially extend people’s lives. On the other hand, for the elderly, too much treatment provides limited benefits in healthily prolonging life. 
“If blood sugar levels are too low for older people, they are at risk of fainting and falling which is particularly dangerous for the elderly—they can break their hip if they fall,” says Dr. Greiver, “Older people sometimes cannot tell if their blood sugar is low. With excessive treatment, the risk of driving sugar levels too low is much greater.”
The problem was compounded when the patient, regardless of age, had one or more chronic medical condition. The team observed that people with fewer chronic medical conditions had moderate glycemic control while those with more chronic diseases had tight glycemic controls. These results were inconsistent with the amended practice guidelines which recommended consideration of more moderate control when people had multiple chronic medical conditions.
Through 537 family physicians, researchers examined data from over 30 000 Canadians across the country and spent two years uncovering the findings, a task Dr. Greiver says was arduous. She maintains that the results are fair, deserve further attention, and could be, perhaps, an important step to improving the personalization of treatment for patients. She argues that patients should have the ability to set individualized targets with their primary care provider to ensure optimum care alongside their health circumstances.
The study is one aspect of a larger endeavour partnering The University of Toronto Practice-Based Research Network (UTOPIAN) and Diabetes Action Canada. The intent of this partnership is to create a data repository using information from primary care providers across the country, that will help foster research to reduce diabetes complication and help people better manage their condition. Dr. Greiver states that this study is a pulse-check and can provide information for family doctors and their teams.
“This study is a stepping stone for more research,” says Greiver, “We cannot improve what we do not measure. We need to know how we are doing. We do not have to accept these results as we all know someone—a friend or a relative—struggling with diabetes. We want to ensure that we can help them achieve a healthier future.”
