ABSTRACT
This chapter discusses four important concepts that should be considered when approaching diabetes management, especially if the goal is to achieve durable glucose control. The first is the need to understand and acknowledge each person’s medical and psychosocial concerns, including those not related to diabetes, when selecting a treatment regime. The second is the need to recognise that the current classification system for diabetes is based on disease aetiology and is therefore limited in its clinical usefulness during medical management decision-making; type of diabetes does not accurately reflect pathophysiologic state. The third is how the current ‘guideline approach’ to diabetes management, with its sequential addition of hypoglycaemics, invariably results in a person’s cycling in and out of good diabetes control; this contrasts with a ‘pathophysiologic approach’, where medications are introduced to address underlying pathologies to achieve a durable reduction in HbA1c. Finally, because we do not have a set of diagnostic tests to accurately distinguish between the different types of diabetes and/or underlying pathologies, the fourth part of the chapter provides a set of diagnostic tests and skills that will help providers to achieve more accurate classification of patients.
