A recent analysis published in BMJ finds that the widespread use of surrogate endpoints in diabetes care puts the patient’s concerns on the back burner. The authors argue that easier-to-measure surrogate outcomes are often used instead of outcomes important to patients, such as death, quality of life, or functional capacity when assessing treatments. 

Diabetes care is largely driven by surrogates. Concentrations of glycated haemoglobin (HbA1c) are used as a surrogate marker for outcomes that are important to patients, such as blindness or amputation. Blood pressure, lipids, albumin excretion rates, and C-reactive protein are other surrogates physicians use to predict outcomes of cardiovascular disease and to guide clinical practice. However, according to the authors, “much of the evidence for clinical interventions is based on their effect on surrogate outcomes rather than those that matter to patients, such as quality of life or avoidance of vision loss or renal failure.”

Surrogates for outcomes such as glucose, lipid, and blood pressure thresholds are also used to evaluate quality of healthcare and influence reimbursements. Focus may then fall on reducing the level of the surrogate, regardless of the impact on a patient’s outlook. The authors maintain that these markers “begin to take on an existence of their own as new disease entities.”

Physician’s Weekly wants to know… Do you feel there is too much focus on surrogate use? Does surrogate use treat the individual as a biological being rather than a human?