Individualized diabetes care: Lessons from the real-world experience

Abstract

Diabetes care is often difficult without a proper collaboration between the patient and the care provider as the disease is mostly self-managed by patients through adjustments in their lifestyles, and medication doses to optimise glycaemic control. Most clinical guidelines on the management of diabetes mellitus (DM) provide only broad principles on diabetes care, and the blind follow-up of such principles without a proper review and consideration of patient characteristics often results in inadequate glycaemic control and diabetes complications consequently. Therefore, a proper understanding of the pathobiology, clinical situation, and comorbidities of the individual case is of paramount importance to tailoring the most appropriate management strategy in real-world diabetes care. With the aid of five unique cases of DM [(1) Medically managed type 2 diabetes mellitus (T2DM) with severe obesity; (2) Management of T2DM with unreliable glycated haemoglobin (HbA1c); (3) Obesity in a patient with type 1 diabetes mellitus (T1DM); and (4) Late diagnosis and subsequent management of monogenic diabetes and 5. Sudden worsening of well-controlled T2DM)] we elaborate on the importance of individualised diabetes care and the practicalities in these situations. The review also provides an evidence update on the management of different forms of DM to guide physicians in optimising the care of their patients in day-to-day clinical practice.

Keywords: Individualised diabetes care, Diabesity, Double diabetes, Monogenic diabetes, Diabetes in pancreatic cancer

Core Tip: Diabetes mellitus (DM) is a chronic disease mostly self-managed by patients as glucose control is largely related to lifestyle adjustments with appropriate dietary habits and physical activities. A proper understanding of the pathobiology of DM, associated comorbidities, the clinical situation, and the socio-cultural background of each patient is of paramount importance in planning the optimal management strategies for diabetes care. With the aid of 5 interesting real-world case scenarios, we elaborate on the importance of individualised diabetes care in this evidence-based review to empower physicians in optimising the care of their diabetes patients in day-to-day clinical practice.