The evidence based guidelines of the German Diabetes Society, the Drug Commission of the German Medical Association, and the International Diabetes Federation recommend an HbA1c measurement of ≤6.5% in people with type 2 diabetes. They state clearly and unequivocally that individualized therapeutic planning is essential, bearing in mind the patient’s age and comorbidities (the younger and healthier the patient, the closer their measurement should be to the recommended target value for HbA1c), and balancing risks and benefits (avoiding severe hypoglycemias, tolerability of the drugs, etc). The patient’s wishes should also be considered after appropriate information has been given. Regulating blood glucose (HbA1cin the region of 5%) is often possible without causing severe hypoglycemias in patients with type 2 diabetes. For several reasons, the VADT, ACCORD, and ADVANCE studies do not translate to patients in Germany without critical analysis (for example, VADT included almost exclusively men, ACCORD deployed therapeutic strategies that are almost never used in Germany, and ethnicity was an issue in ADVANCE). Further, the categorization of the patients into type 1 and type 2 does not do justice to the complexity of diabetes, especially that of type 2 diabetes (1).
Rheohemapheresis is expensive and of limited value for diabetic retinopathy, hence the health insurers justifiably do not cover the procedure.
UBI therapy is not recommended from an ophthalmological perspective.
Footnotes
Conflict of interest statement
Professor Ulbig has received honoraria for speaking and travel expenses from Novartis, Pfizer, Lilly, Bausch & Lomb, TAKEDA, and Sanofi. The CALDIRET study was conducted under the direction of the hospital that employs Professor Ulbig and was funded by Sanofi-Synthelabo.
References
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