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American Diabetes Association® Releases 2018 Standards Of Medical Care In Diabetes, With Notable New Recommendations For People With Cardiovascular Disease And Diabetes

American Diabetes Association® Releases 2018 Standards Of Medical Care In Diabetes, With Notable New Recommendations For People With Cardiovascular Disease And Diabetes

ARLINGTON, Va., Dec. 8, 2017 /PRNewswire/ -- Notable new recommendations in the 2018 edition of the American Diabetes Association's (ADA's) Standards of Medical Care in Diabetes (Standards of Care) include advances in cardiovascular disease risk management including hypertension; an updated care algorithm that is patient-focused; the integration of new technology into diabetes management; and routine screening for type 2 diabetes in high-risk youth (BMI >85th percentile plus at least one additional risk factor). The Standards of Care provide the latest in comprehensive, evidence-based recommendations for the diagnosis and treatment of children and adults with type 1, type 2 or gestational diabetes, strategies to improve the prevention or delay of type 2 diabetes, and therapeutic approaches that reduce complications and positively affect health outcomes. The Standards of Care are published annually and will be available online at 4:00 p.m. ET, December 8, 2017, and as a supplement to the January 2018 print issue of Diabetes Care. Experience the interactive Multichannel News Release here: Beginning in 2018, the ADA will update and revise the online version of the Standards of Care throughout the year with necessary annotations if new evidence or regulatory changes merit immediate incorporation. This will ensure that the Standards of Care provide clinicians, patients, researchers, health plans and policymakers with the most up-to-date components of diabetes care, general treatment goals and tools to evaluate the quality of care. The Standards of Care will also be available as a user-friendly and interactive app for both web and mobile devices in the spring of 2018. The app will allow clinicians to access the most up-to-date information conveniently and will include interac Continue reading >>

Ada Releases Standards Of Medical Care For Patients With Diabetes

Ada Releases Standards Of Medical Care For Patients With Diabetes

Diabetes requires continuing medical care and patient self-management to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues—not only glycemic control—be managed. To address these issues, the American Diabetes Association (ADA) published a position statement containing evidence-based recommendations for diabetes care, treatment goals, and tools to evaluate the quality of care. The full statement, “Standards of Medical Care in Diabetes—2006,” was published in the January 2006 supplement to Diabetes Care. Screening Type 2 diabetes usually is not diagnosed until complications develop, and approximately one third of all persons with diabetes may be undiagnosed. Screening to detect prediabetes should be considered in persons 45 years and older, particularly in persons with a body mass index (BMI) of at least 25 kg per m2. Screening also should be considered in persons who are younger than 45 years if they are overweight and have an additional risk factor (Table 1). Screening for prediabetes and diabetes should be performed in high-risk, asymptomatic children (Table 2) and adults. If test results are normal, repeat testing should be performed at three-year intervals in adults and at two-year intervals in children. TABLE 1 Testing should be considered in all persons 45 years and older, particularly in persons with a BMI of 25 kg per m2 or greater. If test results are normal, testing should be repeated at three-year intervals. Testing should be considered in younger persons and performed more frequently in persons with a BMI of 25 kg per m2 or greater who have additional risk factors, such as those who: Are habitually physically inactive Are members of a high-risk ethnic population (e.g. Continue reading >>

Become A Professional Member Of The American Diabetes Association® And Expand Your Knowledge, Enhance Your Perspective And Grow Your Connections Through Exclusive Opportunities And Unmatched Resources That Come Only With Membership.

Become A Professional Member Of The American Diabetes Association® And Expand Your Knowledge, Enhance Your Perspective And Grow Your Connections Through Exclusive Opportunities And Unmatched Resources That Come Only With Membership.

Your work is critical in the fight against diabetes. Be part of the world's most respected organization devoted to understanding, treating, preventing and conquering the disease. Distinguished journals and publications, meeting discounts, Interest Group opportunities, Continuing Education Programs, Patient Education materials, newsletters... plus many more valuable resources make Association membership indispensable. * Includes both print and online editions except where noted. ** Includes significant registration and materials discounts to other Association meetings and live courses. Whichever option you select, you'll be welcomed by more than 14,000 other diabetes professionals who share your interests and experiences, and who are determined to make a difference through their work and their membership. Be assured that Professional Membership in the American Diabetes Association is one of the most beneficial decisions you can make. Continue reading >>

6. Glycemic Targets

6. Glycemic Targets

Assessment of Glycemic Control Two primary techniques are available for health providers and patients to assess the effectiveness of the management plan on glycemic control: patient self-monitoring of blood glucose (SMBG) or interstitial glucose and A1C. Continuous glucose monitoring (CGM) may be a useful adjunct to SMBG in selected patients. Recommendations When prescribed as part of a broader educational context, SMBG results may help guide treatment decisions and/or self-management for patients using less frequent insulin injections B or noninsulin therapies. E When prescribing SMBG, ensure that patients receive ongoing instruction and regular evaluation of SMBG technique, SMBG results, and their ability to use SMBG data to adjust therapy. E Patients on multiple-dose insulin or insulin pump therapy should perform SMBG prior to meals and snacks, occasionally postprandially, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normoglycemic, and prior to critical tasks such as driving. B When used properly, CGM in conjunction with intensive insulin regimens is a useful tool to lower A1C in selected adults (aged ≥25 years) with type 1 diabetes. A Although the evidence for A1C lowering is less strong in children, teens, and younger adults, CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device. B CGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes. C Given variable adherence to CGM, assess individual readiness for continuing use of CGM prior to prescribing. E When prescribing CGM, robust diabetes education, training, and support are required for optimal CGM implementation and ongoing use. E Self-monit Continue reading >>

Science And Practice Commentary Comparison Of The Diabetes Guidelines From The Ada/easd And The Aace/ace

Science And Practice Commentary Comparison Of The Diabetes Guidelines From The Ada/easd And The Aace/ace

Abstract To compare recent diabetes guideline updates from the American Diabetes Association–European Association for the Study of Diabetes (ADA/EASD) and the American Association of Clinical Endocrinologists–American College of Endocrinology (AACE/ACE). The ADA/EASD guideline continues to advocate a stepwise approach to glycemic control that initiates with metformin and intensifies treatment incrementally to dual and triple therapy at 3-month intervals until the patient is at their individualized goal. The AACE/ACE guideline provides a broader choice of first-line medications, with a suggested hierarchy of use, and it encourages initial dual and triple therapy if the glycated hemoglobin (A1C) level is high enough at diagnosis (7.5%-9.0% and >9.0%, respectively). Target A1C levels are higher in the ADA/EASD guideline (≤7.0%) compared with the AACE/ACE guideline (≤6.5%), although both statements indicate that targets should be adjusted to specific clinical scenarios based on safety. Both guidelines now include the new sodium-glucose cotransporter-2 inhibitors among their choices of acceptable glucose-lowering medications and endorse the overall cardiovascular and pancreatic safety of incretin therapies, and the safety of pioglitazone vis-a-vis bladder cancer. In practice, the ADA/EASD guidelines tend to be more user-friendly for general practitioners because of the simple stepwise intensification regimen, whereas the AACE/ACE guidelines are more commonly followed by specialists (endocrinologists) because of the more aggressive A1C targets. Continue reading >>

Ada Offers Position Statement On Diabetes And Hypertension

Ada Offers Position Statement On Diabetes And Hypertension

The American Diabetes Association (ADA) today offered a position statement on treating diabetes and hypertension for the first time since 2003. The American Diabetes Association (ADA) today offered a position statement on treating diabetes and hypertension for the first time since 2003. The statement incorporates findings from several key studies since that time, notably the 2010 ACCORD study (Action to Control Cardiovascular Risk in Diabetes). The statement, published in the journal Diabetes Care, features recommendations for diagnosing hypertension in patients with diabetes and an algorithm treating them, depending on how elevated their blood pressure is. The authors note that hypertension is a strong risk factor in atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications that are the hallmarks of advanced diabetes, which contribute to both direct and indirect costs. In 2013, the ADA found that the annual costs of diabetes in the United States totaled $245 billion. Those with a blood pressure between 140/90 mm Hg and 160/100 mm Hg should start on a single antihypertensive agent, and those with a reading higher than 160/100 mg Hg should immediately start with 2 agents; both groups should improve their lifestyle management. The algorithm goes on to recommend specific agents depending on whether patients meet targets or experience adverse effects. The guideline continues the advice that most patients with diabetes should be treated to a blood pressure goal of <140/90 mm Hg; a goal of <130/80 can be considered for patients who have other cardiovascular risk factors. This follows results of ACCORD BP, which found no difference in a composite of cardiovascular events for patients whose blood pressure was treated to a much lower target o Continue reading >>

Goals For Blood Glucose Control

Goals For Blood Glucose Control

People who have diabetes should be testing their blood glucose regularly at home. Regular blood glucose testing helps you determine how well your diabetes management program of meal planning, exercising and medication (if necessary) is doing to keep your blood glucose as close to normal as possible. The results of the nationwide Diabetes Control and Complications Trial (DCCT) show that the closer you keep your blood glucose to normal, the more likely you are to prevent diabetes complications such as eye disease, nerve damage, and other problems. For some people, other medical conditions, age, or other issues may cause your physician to establish somewhat higher blood glucose targets for you. The following chart outlines the usual blood glucose ranges for a person who does and does not have diabetes. Use this as a guide to work with your physician and your healthcare team to determine what your target goals should be, and to develop a program of regular blood glucose monitoring to manage your condition. Time of Check Goal plasma blood glucose ranges for people without diabetes Goal plasma blood glucose ranges for people with diabetes Before breakfast (fasting) < 100 70 - 130 Before lunch, supper and snack < 110 70 - 130 Two hours after meals < 140 < 180 Bedtime < 120 90- 150 A1C (also called glycosylated hemoglobin A1c, HbA1c or glycohemoglobin A1c) < 6% < 7% < = less than > = greater than > = greater than or equal to < = less than or equal to Information obtained from Joslin Diabetes Center's Guidelines for Pharmacological Management of Type 2 Diabetes. Continue reading >>

Your A1c Levels – What Goal To Shoot For?

Your A1c Levels – What Goal To Shoot For?

Measuring Your A1C An A1C test gives you and your provider insight into all of your blood glucose ups and downs over the past two or three months. It’s like the 24/7 video of your blood sugar levels. Observing your A1C results and your blood glucose (also known as blood sugar) results together over time are two of the key tools you and your health care provider can use to monitor your progress and revise your therapy as needed over the years. Recent research is changing the way health professionals look at A1C levels. Instead of setting tight controls across the board, a healthy A1C level is now a moving target that depends on the patient. In the past, an A1C of 7 percent was considered a healthy goal for everyone. Yehuda Handelsman, M.D., medical director of the Metabolic Institute of America in Tarzana, California, says experts now recommend taking a patient-centered approach to managing A1C levels, which means evaluating goals based on individual diabetes management needs and personal and lifestyle preferences. Current ADA Goals The 2015 American Diabetes Association (ADA) Standards of Medical Care in Diabetes advise the following A1C levels: • 6.5 percent or less: This is a more stringent goal. Health care providers might suggest this for people who can achieve this goal without experiencing a lot of hypoglycemia episodes or other negative effects of having lower blood glucose levels. This may be people who have not had diabetes for many years (short duration); people with type 2 diabetes using lifestyle changes and/or a glucose-lowering medication that doesn’t cause hypoglycemia; younger adults with many years to live healthfully; and people with no significant heart and blood vessel disease. • 7 percent: This is a reasonable A1C goal for many adults with d Continue reading >>

Tailoring Treatment To Reduce Disparities:

Tailoring Treatment To Reduce Disparities:

The American Diabetes Association (ADA) publishes the Standards of Medical Care in Diabetes annually, based on the latest medical research. The following narrative provides a summary of the 2017 updated recommendations that have been developed for clinical practice. The ADA guidelines are not intended to aid or preclude clinical judgment. The full guidelines can be accessed at ADA’s Diabetes Pro website. Tailoring Treatment to Reduce Disparities: Updated guidelines focus on improving outcomes and reducing disparities in populations with diabetes such as: Ethnic/Cultural/Sex/Socioeconomic Differences and Disparities: Provide structured interventions that are tailored to ethnic populations and integrate culture, language, religion, and literacy skills. Food Insecurity: Evaluate hyperglycemia and hypoglycemia in the context of food insecurity (FI), which is defined as the unreliable availability of nutritious food. Recognize that homelessness and poor literacy and numeracy often occur with FI. Propose solutions and resources accordingly. Comprehensive Medical Evaluation and Assessment of Comorbidities: The clinical evaluation should include conversation about lifestyle modifications and healthy living. PAs should address barriers including patient factors (e.g., remembering to obtain or take medications, fears, depression, and health beliefs), medication factors (e.g., complex directions, cost) and system factors (e.g., inadequate follow up). Simplifying treatment regimens may improve adherence. This section highlights the elements of a patient-centered comprehensive medical exam, including the importance of assessing comorbidities such as: Cognitive Dysfunction: Tailor glycemic therapy to avoid significant hypoglycemia. Cardiovascular benefits of statin therapy outweigh Continue reading >>

Blood Sugar Goals

Blood Sugar Goals

Blood Sugar Goals Where should blood sugar be to avoid complications? Normalizing blood sugar is the main goal. Strive to get blood sugar close to that of a healthy person who does not have diabetes. Several organizations provide recommendations for blood sugar testing goals. The goal of blood sugar depends on when you are testing - before a meal (pre-prandial), after a meal (post-prandial), prior to going to bed. Each organization below provides guidelines for a variety of blood sugar testing times. What are normal blood sugar ranges for healthy people? The American Diabetes Association acknowledges these as normal blood sugar for healthy people who do not have diabetes: fasting/before eating < 100 mg/dl bedtime 120 mg/dl A1c blood sugar test (3 month blood sugar indicator) <6% What does the American Diabetes Association recommend for those with diabetes? The American Diabetes Association recommends the following blood sugar goals for those with diabetes: before eating (pre-prandial plasma glucose) 90-130 mg/dl 1-2 hours after the beginning of eating (peak post-prandial plasma glucose) <180 mg/dl A1c blood sugar test (3 month blood sugar indicator) <7% What do other organizations recommend for blood sugar goals? The American Association of Clinical Endocrinologists (endocrinologists are medical doctors specializing in disorders including diabetes) recommends the following blood sugar goals for those with diabetes: before eating (pre-prandial) 110 mg/dl 2 hours after eating (post-prandial) 140 mg/dl A1c blood sugar test (3 month blood sugar indicator) <6.5% Each person may have different goals for treating their diabetes. It is important to discuss blood sugar control goals with your diabetes educator or doctor so you know what to personally try to achieve. Learn more a Continue reading >>

Ada Tightens A1c Goals For Children

Ada Tightens A1c Goals For Children

The ADA calls for better blood glucose control in its first-ever Type 1 diabetes position paper. Scientists from the American Diabetes Association (ADA) held an open Twitter chat to discuss new guidelines for children with Type 1 diabetes, as part of the rollout of the association’s first Type 1-only position paper. Endocrinologists Dr. Jane Chiang and Dr. Sue Kirkman fielded questions for the ADA. In a move that stirred up online chatter, the ADA tightened its A1C goals for children. Previously, ADA guidelines called for A1C goals of 8.5 or lower for children under 6 years old, 8.0 or lower for children ages 6 to 12, and then 7.5 or lower for teens. The new guidelines now call for an A1C score of 7.5 or lower for all children, regardless of age. The recently-released position paper is the first from the ADA to discuss Type 1 diabetes exclusively. In the past, Type 1 and Type 2 guidelines were lumped together. Issuing Type 1-only position papers will help physicians focus on the unique characteristics and treatment options for Type 1, Dr. Chiang said. “Diabetes is not a one-size-fits-all disease, and it’s important that we recognize that,” Dr. Chiang said A1C goals for children were tightened because new research shows that children with high blood glucose levels before puberty are at greater risk for heart and kidney problems later on in life, according to Dr. Chiang. A1C guidelines always must balance the long-term health impact of high blood glucose levels with the short-term danger of hypoglycemia. In the past, an A1C goal of 7.5 or lower for children seemed too difficult to reach without risking increased hypoglycemia. Dr. Kirkman believes that pumps and other advances in diabetes home care technology will now make such a goal more attainable without dire r Continue reading >>

Type 2 Diabetes: Ada, Aace/ace Update Recommendations

Type 2 Diabetes: Ada, Aace/ace Update Recommendations

The American Diabetes Association (ADA) and American Association of Clinical Endocrinologists, in conjunction with the American College of Endocrinology (AACE/ACE), have released updated recommendations for type 2 diabetes management and care. The documents bring new evidence to bear on standard of care. Screening New in 2016, ADA recommends that all adults aged 45 years and older be screened for type 2 diabetes. “We’ve seen a lot of recent evidence that shows that BMI [body mass index] isn’t necessarily the best corollary for risk. Some people can have a healthy BMI and still develop diabetes,” said Andrew Bzowyckyj, PharmD, BCPS, CDE, coordinator-elect for the APhA Academy of Pharmacy Practice & Management Diabetes Management Special Interest Group. Obesity Both ADA and AACE/ACE added emphasis this year on management of overweight and obesity as a means of treating and delaying type 2 diabetes. Recommendations, which include medication and behavior modification, are not new—but the emphasis is. “Traditionally, ADA has spread its obesity-related recommendations across multiple different areas. Now they’ve devoted a three- to four-page chapter to it. It’s a condensed, easy-to-use resource,” said Bzowyckyj. “The average patient does not appreciate the fact that a 10% weight loss reduces the metabolic risk and cardiovascular complications surrounding diabetes. Pharmacists can make that point,” said Alan Garber, MD, PhD, FACE, chair of the AACE/ACE Algorithm Taskforce. Medications ADA’s recommendation for aspirin therapy now extends to women with type 2 diabetes aged 50 years and older who have at least one other risk factor for cardiovascular disease. “The recommendation reflects new evidence on atherosclerotic cardiovascular disease risk among w Continue reading >>

Clinical Use

Clinical Use

Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. From the Executive Summary of the 2014 American Diabetes Association Clinical Practice Recommendations (Diabetes Care 2014;37,suppl.1:S5-13) Consider A1C targets as close to non-diabetic levels (< 6.5 percent) as possible without significant hypoglycemia in people with short duration of diabetes, little comorbidity, and long life expectancy. Consider less stringent A1C targets (e.g., 8 percent) for people with a history of severe hypoglycemia, limited life expectancy, extensive comorbid conditions, advanced complications, major impairments to self-management (e.g., visual, cognitive, social), or long-standing diabetes where the A1C goal is difficult to attain despite optimal efforts. Reassess A1C targets and change (lower or higher) as appropriate. From: National Diabetes Education Program website on Guiding Principles, When interpreting laboratory results health care providers should: be informed about the A1C assay methods used by their laboratory send blood samples for diagnosis to a laboratory that uses an NGSP-certified method for A1C analysis to ensure the results are standardized consider the possibility of interference in the A1C test when a result is above 15% or is at odds with other diabetes test results consider each patient’s profile, including risk factors and history, and individualize diagnosis and treatment decisions in discussion with the patient From: National Diabetes Information Clearinghouse (NDIC), Links to clinical guidelines from other organizations are listed below; the NGSP does not endorse specific guideli Continue reading >>

Type 2 Diabetes Glucose Management Goals

Type 2 Diabetes Glucose Management Goals

Optimal management of type 2 diabetes requires treatment of the “ABCs” of diabetes: A1C, blood pressure, and cholesterol (ie, dyslipidemia). This web page provides the rationale and targets for glucose management; AACE guidelines for blood pressure and lipid control are summarized in Management of Common Comorbidities of Diabetes. Glucose Targets Glucose goals should be established on an individual basis for each patient, based on consideration of both clinical characteristics and the patient's psycho-socioeconomic circumstances.1-3 Accordingly, AACE recommends individualized glucose targets (Table 1) that take into account the following factors1,2: Life expectancy Duration of diabetes Presence or absence of microvascular and macrovascular complications Comorbid conditions including CVD risk factors Risk for development of or consequences from severe hypoglycemia Patient's social, psychological, and economic status Table 1. AACE-Recommended Glycemic Targets for Nonpregnant Adults1,2 Parameter Treatment Goal Hemoglobin A1C Individualize on the basis of age, comorbidities, and duration of disease ≤6.5 for most Closer to normal for healthy Less stringent for “less healthy” Fasting plasma glucose (FPG) <110 mg/dL 2-hour postprandial glucose (PPG) <140 mg/dL The American Diabetes Association (ADA) also recommends individualizing glycemic targets (Table 2) based on patient-specific characteristics3: Patient attitude and expected treatment efforts Risks potentially associated with hypoglycemia as well as other adverse events Disease duration Life expectancy Important comorbidities Established vascular complications Resources and support system Table 2. ADA-Recommended Glycemic Targets for Nonpregnant Adults3 Parameter Treatment Goal Hemoglobin A1C <6.5% for patients Continue reading >>

New Ada 2017 Standards Of Medical Care In Diabetes

New Ada 2017 Standards Of Medical Care In Diabetes

Psychological health, access to care, expanded and personalized treatment options and the tracking of hypoglycemia emphasized. The ADA Standards of Medical Care in Diabetes are established and revised annually by a Professional Practice Committee. The committee is a multi-disciplinary team of 12 leading experts in the field of diabetes care, and includes physicians, diabetes educators, registered dietitians and others who have experience in areas that include adult and pediatric endocrinology, epidemiology, public health, lipid research, hypertension, preconception planning and pregnancy care. Members of the committee must disclose potential conflicts of interest with industry and/or other relevant organizations. Psychological health, access to care, expanded and personalized treatment options, and the tracking of hypoglycemia in people with diabetes are key areas emphasized in the American Diabetes Association’s (Association) new 2017 Standards of Medical Care in Diabetes (Standards). Produced annually by the Association, the guidelines focus on screening, diagnosis and treatment to provide better health outcomes for children, adults and older people with type 1, type 2 or gestational diabetes, and to improve the prevention and delay of type 2 diabetes. The Standards were published as a supplement to the January 2017 issue of Diabetes Care. The Standards also include the findings of a new report on diabetes staging, titled “Differentiation of Diabetes by Pathophysiology, Natural History and Prognosis” (Differentiation), which is being published at the same time in Diabetes. Produced by a joint symposium of the Association, JDRF, the European Association for the Study of Diabetes and the American Association of Clinical Endocrinologists, the Differentiation report Continue reading >>

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