Customizing therapies for patients with diabetes and cardiovascular disease to accommodate personal circumstances may help those individuals enjoy an improved quality of life by offering simpler self-care steps that may improve adherence.
Duke endocrinologist Leonor Corsino, MD, MHS, says custom therapies vary occasionally from established guidelines governing hypertension or cholesterol targets. While acknowledging the essential role of guidelines, Corsino cautions that many patients will be more adherent with personalized therapies prepared with insights into the patient’s lifestyle and unique challenges.
Endocrinologists typically work with patients managing more complex conditions following primary care referrals. Many patients have comorbidities as well as personal factors that compound risk. “We all want to follow guidelines, that’s how we are assessed professionally,” she says. “But in some cases, we should realize we may be causing more harm because they are difficult to follow, they are costly, or they introduce the risk of side effects.”
Older patients who live alone, for example, maybe at greater risk for falls as a result of medications that could trigger hypostatic conditions. Others may not be able to pay for newer, more expensive medications.
“If you have a patient with advanced cancer and shorter life expectancy, why push for an A1c or cholesterol goal that doesn’t make sense given potential quality of life issues,” she says. “We must remember that we are treating unique humans with varied needs.”
Corsino’s objective is to incorporate relevant guideline-directed treatments into a collaborative, patient-centered approach. She encourages endocrinologists to consider a patient’s personal circumstances to treat comorbidities more effectively.
“We all have empathy for our patients and try to accommodate them,” Corsino says. “But I have many patients who are not able to follow our guidance because it’s simply too much for them. They may not be willing or able to change the complex circumstances in their lives to follow our guidance.”
Corsino urges endocrinologists to take the following steps to develop customized therapies:
- Establish less-demanding targets for older adults with diabetes, cardiovascular disease and related comorbidities to improve quality of life. Corsino recommends that clinicians focus on the distinctive challenges in treating older patients.
- Incorporate patient functionality into quality-of-life assessments weighted as equally as age.
- Seek accurate measures of blood pressure and related risk factors outside the clinic.
- Assess long-term cardiovascular disease risk when setting targets.
- Consider patients’ ability to pay when recommending a therapy. Insurance coverage, Corsino notes, does not guarantee that a patient can afford medication. When possible, prescribe more affordable drugs.
- Encourage such lifestyle changes as increased exercise and improved diet in conjunction with medications.