Evidence-Based Medicine May Reduce Overtreatment in Type 2 Diabetes

In the United States, the overuse of medical care accounts for approximately 20% of the $750 billion in wasteful health care spending. In a paper recently published inCirculation, investigators proposed the implementation of evidence-based medicine (EBM).

EBM is an approach that embraces individualized care to prevent overtreatment, including balancing absolute benefits and harms with the physician’s judgement and the patient’s values and preferences.

The authors hope the paper will be a call to action for applying EBM principles for researchers, policy leaders, medical educators, and physicians. The overall goal is to individualize treatment decisions and improve the well-being and health of patients, particularly those with type 2 diabetes.

“Evidence-based medicine is a powerful tool to provide person-centered care to individuals with type 2 diabetes, as well as for patients with other diseases,” said lead author Dr. Anil Makam. “When applied to type 2 diabetes, EBM calls for a paradigm shift in our treatment approach.”

The authors propose that intensive blood glucose treatment should not be a universal goal of care for patients with type 2 diabetes in order to preventovertreatment.

Currently, the standard of care recommends a strict control of blood glucose—–defined as hemoglobin A1c levels of less than 7%. However, evidence shows that this approach offers only modest potential benefit. Furthermore, it can decrease the quality of life in patients due to the treatment burden itself, and there is also potential harm from therapy.

In order to achieve any benefit, it can take up to 2 decades of strict blood glucose control. Older patients, however, can be successfully treated by achieving more modest blood glucose goals (hemoglobin A1c levels of 8.5% to 9%). This can help maintain treatment benefits while minimizing potential harm, according to the study.

“EBM is often misunderstood as a call for universal, cookie-cutter medicine, which has led to an epidemic of overtreatment in type 2 diabetes,” said senior author Dr. Oanh Nguyen. “Instead EBM is a critical tool in the physician’s arsenal to provide individualized and person-centered care.”

Type 2 diabetes affects more than 29 million individuals in the United States, according to the CDC.