Creating Treatment Guidelines

In 2006, a panel formed by the National Committee for Quality Assurance, an organization that sets treatment guidelines often used by insurance companies to determine their reimbursement policies, unanimously recommended that doctors pursue intensive blood glucose control in nearly all people with diabetes. But in early 2008, the group withdrew its guideline after the intensive-control arm of the ACCORD (Action to Control Cardiovascular Risk in Diabetes) Study was halted due to a significantly higher death rate in that group of participants. The earlier studies that the group had considered, it seems, did not include enough people with cardiovascular disease.

According to a New York Times article published last week, this episode shows some of the general hazards posed by treatment guidelines, as well as some possible flaws in the system used to create them. The original guidelines produced by the National Committee for Quality Assurance seem to have failed to take into account a significant subset of people with Type 2 diabetes, those with cardiovascular disease. But no treatment guidelines can carve out exceptions for every situation in which standard treatment may not be the best. Thus, they should ideally strike a balance between educating doctors and allowing doctor discretion. It is important to remember, however, that the guidelines in question are not simply clinical practice recommendations such as those issued by the American Diabetes Association. Instead, they are used to determine, in some cases, how doctors are paid by insurance companies for treating people.

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What do you think — what is the appropriate balance between allowing the discretion of doctors and enforcing the accepted best practices for treatment? Should payment from insurance companies be tied to how closely doctors adhere to treatment guidelines? And given that there is conflicting evidence regarding tight blood glucose control and risk of death, how should treatment guidelines account for such a situation? Was the National Committee for Quality Assurance too quick to jump on one study and ignore the benefits of tight blood glucose control? Leave a comment below!

  • Sam Frandisco

    I think isurance companies need to stop playing doctor. All they care about is money. Not their clients, not doctors, just money. I have had insurance companies change my medication without contacting my doctor. Who died and made them god? No wonder healthcare is so screwed-up. The insurance companies are greedy at the expense of our health. We need to do away with insurance companies, all of them.

  • Tom P

    Treatment should be left entirely to the discretion of the treating physician and the patient. Insurance companies are NOT the police. Errors in treatment are best left to medical authorities and legal authorities. There is no doubt in my mind that insurance companies exist ONLY for their own profit – it’s a business. No matter who establishes the guidelines for treatment, it should not be the insurance companies’ prerogative to refuse to pay for treatments deemed necessary by treating physicians.

    Healthcare/Insurance reform must become a mandate and this is only one reason why.

  • Paula Kilburn

    As long as a legitimate doctor has prescribed the medicine and equipment needed to control diabetes, the insurance company and/or Social Security shouldn’t disallow the doctor’s orders and short change the patient of medicine or medical supplies. My control is tweaked constantly by my doctor and when insurance companies and/or Social Security go by their guidelines my diabetes suffers.

  • Harry…………………….

    Through tight control of my blood glucose I managed to loose 90 lbs. Lower the amount of medication I need and simply stay awake more hours during the day. Anything isn’t medicine its mad!