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Diabetes Screening Guidelines 2016

Diabetes Mellitus: Screening And Diagnosis

Diabetes Mellitus: Screening And Diagnosis

Diabetes mellitus is one of the most common diagnoses made by family physicians. Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure, and vascular and heart disease. Screening patients before signs and symptoms develop leads to earlier diagnosis and treatment, but may not reduce rates of end-organ damage. Randomized trials show that screening for type 2 diabetes does not reduce mortality after 10 years, although some data suggest mortality benefits after 23 to 30 years. Lifestyle and pharmacologic interventions decrease progression to diabetes in patients with impaired fasting glucose or impaired glucose tolerance. Screening for type 1 diabetes is not recommended. The U.S. Preventive Services Task Force recommends screening for abnormal blood glucose and type 2 diabetes in adults 40 to 70 years of age who are overweight or obese, and repeating testing every three years if results are normal. Individuals at higher risk should be considered for earlier and more frequent screening. The American Diabetes Association recommends screening for type 2 diabetes annually in patients 45 years and older, or in patients younger than 45 years with major risk factors. The diagnosis can be made with a fasting plasma glucose level of 126 mg per dL or greater; an A1C level of 6.5% or greater; a random plasma glucose level of 200 mg per dL or greater; or a 75-g two-hour oral glucose tolerance test with a plasma glucose level of 200 mg per dL or greater. Results should be confirmed with repeat testing on a subsequent day; however, a single random plasma glucose level of 200 mg per dL or greater with typical signs and symptoms of hyperglycemia likely indicates diabetes. Additional testing to determine the etiology of diabetes is not routinely recommended. Clinical r Continue reading >>

American Diabetes Association (ada) Guidelines: Criteria For Diabetes Diagnosis

American Diabetes Association (ada) Guidelines: Criteria For Diabetes Diagnosis

The American Diabetes Association's (ADA's) updated 2015 guidelines include recommendations for screening and criteria for the diagnosis of diabetes. The ADA recommends using these 4 criteria for diabetes diagnosis (4 testing options): Hemoglobin A1C ≥6.5%* - Perform in laboratory using National Glycohemoglobin Standardization Program (NGSP)-certified method and standardized to the Diabetes Control and Complications Trial (DCCT) assay. Fasting plasma glucose (FPG) ≥126 mg/dL (7.0 mmol/L)* - Fasting defined as no caloric intake for ≥8 hours. 2-hour plasma glucose (PG) ≥200 mg/dL (11.1 mmol/L) during oral glucose tolerance test (OGTT) (75-g)* - Performed as described by the World Health Organization (WHO), using glucose load containing the equlivalent of 75 g anhydrous glucose dissolved in water. Random plasma glucose (PG) ≥200 mg/dL (11.1 mmol/L) - In persons with symptoms of hyperglycemia or hyperglycemic crisis. * In the absence of unequivocal hyperglycemia results should be confirmed using repeat testing. * Unless clinical diagnosis is clear, same test to be repeated using a new blood sample for confirmation. * Two discordant results? Result above cutpoint should be repeated. Source: Diabetes management guidelines (2015). National Diabetes Education Initiative web site. Available at: Accessed February 17, 2016. Continue reading >>

Acog Releases Updated Guidance On Gestational Diabetes

Acog Releases Updated Guidance On Gestational Diabetes

SUMMARY: ACOG has released updated guidance on gestational diabetes (GDM), which has become increasingly prevalent worldwide. Highlights and changes from the previous practice bulletin include the following: Fetal Monitoring Screening for GDM – One or Two Step? ACOG (based on NIH consensus panel findings) still supports the ‘2 step’ approach (24 – 28 week 1 hour venous glucose measurement following 50g oral glucose solution), followed by a 3 hour oral glucose tolerance test (OGTT) if positive Note: While the diagnosis of GDM is based on 2 abnormal values on the 3 hour OGTT, ACOG states, due to known adverse events, one abnormal value may be sufficient to make the diagnosis 1 step approach (75 g OGTT) on all women will increase the diagnosis of GDM but sufficient prospective studies demonstrating improved outcomes still lacking ACOG does acknowledge that some centers may opt for ‘1 step’ if warranted based on their population Who Should be Screened Early? ACOG has adopted the NIDDK / ADA guidance on screening for diabetes and prediabetes which takes in to account not only previous pregnancy history but also risk factors associated with type 2 diabetes. Screen early in pregnancy if: Patient is overweight with BMI of 25 (23 in Asian Americans), and one of the following: Physical inactivity Known impaired glucose metabolism Previous pregnancy history of: GDM Macrosomia (≥ 4000 g) Stillbirth Hypertension (140/90 mm Hg or being treated for hypertension) HDL cholesterol ≤ 35 mg/dl (0.90 mmol/L) Fasting triglyceride ≥ 250 mg/dL (2.82 mmol/L) PCOS, acanthosis nigricans, nonalcoholic steatohepatitis, morbid obesity and other conditions associated with insulin resistance Hgb A1C ≥ 5.7%, impaired glucose tolerance or impaired fasting glucose Cardiovascular disea Continue reading >>

Updated Guidelines On Screening For Gestational Diabetes

Updated Guidelines On Screening For Gestational Diabetes

1Department of Medicine, Government Medical College and Hospital, Chandigarh, India; 2Bharti Hospital, Karnal, Haryana, India; 3Excel Center, Guwahati, Assam, India; 4Saket City Hospital, New Delhi, India Abstract: Gestational diabetes mellitus (GDM) is associated with an increased risk of complications for both mother and baby during pregnancy as well as in the postpartum period. Screening and identifying these high-risk women is important to improve short- and long-term maternal and fetal outcomes. However, there is a lack of international uniformity in the approach to the screening and diagnosis of GDM. The main purpose of this review is to provide an update on screening for GDM and overt diabetes during pregnancy, and discuss the controversies in this field. We take on debatable issues such as adoption of the new International association of diabetes and pregnancy study groups criteria instead of the Carpenter and Coustan criteria, one-step versus two-step screening, universal screening versus high-risk screening before 24 weeks of gestation for overt diabetes, and, finally, the role of HbA1c as a screening test of GDM. This discussion is followed by a review of recommendations by professional bodies. Certain clinical situations, in which a pragmatic approach is needed, are highlighted to provide a comprehensive overview of the subject. Keywords: pregnancy, guidelines, IADPSG, GDM, Carpenter and Coustan criteria Gestational diabetes mellitus (GDM) has classically been defined as any glucose intolerance first identified during pregnancy.1 Recently, the American Diabetes Association (ADA) defined it as “Diabetes diagnosed in the second or third trimester of pregnancy that is not clearly overt diabetes”.2 However, as per IADPSG (International association of diabete Continue reading >>

Uspstf Diabetes Screening Recommendations Are Cost-effective

Uspstf Diabetes Screening Recommendations Are Cost-effective

USPSTF Diabetes Screening Recommendations Are Cost-effective NEW ORLEANS The US Preventive Services Task Force (USPSTF) recommendation that overweight and obese adults aged 40 to 70 be screened for abnormal glucose levels is cost-effective, relative to no screening or the previous USPSTF guideline, according to a study presented here at the American Diabetes Association (ADA) 2016 Scientific Sessions . The USPTF made the latest recommendation in October 2015, giving it a grade B for moderate evidence of benefit. Patients with abnormal glucose levels should be referred to programs that promote a healthy diet and physical activity, said the panel, which had previously advised in 2008 that only asymptomatic individuals with hypertension (blood pressure > 135/80 mm Hg) should be screened for abnormal blood glucose levels. The new recommendation has policy implications "because under the Affordable Care Act, any preventive service that gets a grade A or B by the task force is then going to be covered by most health insurance plans, and most health insurance plans are going to cover it with no cost sharing," said Thomas J Hoerger, PhD, senior fellow in health economics and financing at RTI International, in Research Triangle Park, North Carolina, which conducts research for the US Centers for Disease Control and Prevention (CDC) and Center for Medicare and Medicaid Services. Dr Hoerger found that screening overweight and obese individuals for abnormal glucose followed by lifestyle interventions or medical therapy is cost-effective but still involves a fairly high cost of about $29,000 per quality-adjusted life-year (QALY). Screening will "have an effect on costs, but it looks to be of good value," he said. Rozalina G McCoy, MD, an endocrinologist at the Mayo Clinic, Rocheste Continue reading >>

Diagnosis And Management Of Diabetes: Synopsis Of The 2016 American Diabetes Association Standards Of Medical Care In Diabetes Free

Diagnosis And Management Of Diabetes: Synopsis Of The 2016 American Diabetes Association Standards Of Medical Care In Diabetes Free

Description: The American Diabetes Association (ADA) published the 2016 Standards of Medical Care in Diabetes (Standards) to provide clinicians, patients, researchers, payers, and other interested parties with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Methods: The ADA Professional Practice Committee performed a systematic search on MEDLINE to revise or clarify recommendations based on new evidence. The committee assigns the recommendations a rating of A, B, or C, depending on the quality of evidence. The E rating for expert opinion is assigned to recommendations based on expert consensus or clinical experience. The Standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community was incorporated into the 2016 revision. Recommendations: The synopsis focuses on 8 key areas that are important to primary care providers. The recommendations highlight individualized care to manage the disease, prevent or delay complications, and improve outcomes. Since 1989, the American Diabetes Association (ADA) Standards of Medical Care in Diabetes (Standards) have provided the framework for evidence-based recommendations to treat patients with diabetes. This synopsis of the 2016 ADA Standards highlights 8 areas that are important to primary care providers: diagnosis, glycemic targets, medical management, hypoglycemia, cardiovascular risk factor management, microvascular disease screening and management, and inpatient diabetes management. Guideline Development and Evidence Grading Recommendations for Glycemic Targets Medical Management of Diabetes Type 1 Diabetes Type 2 Diabetes Cardiovascu Continue reading >>

Updated Guidelines For Diabetes Released By The American Diabetes Association

Updated Guidelines For Diabetes Released By The American Diabetes Association

New recommendations concerning cholesterol lowering drugs for all patients with diabetes, a lower BMI cut point for screening Asian Americans for diabetes, and new blood sugar targets for children and adolescents are among the many the updates in the American Diabetes Association’s (ADA’s) annual revised Standards of Medical Care, which was published in the January issue of Diabetes Care. Managing the Risk for Heart Disease The ADA now recommends that all people with type 2 diabetes take the cholesterol lowering drugs—statins in addition to lifestyle therapy (meal planning changes and exercise) to reduce the likelihood of developing heart disease (eg, heart attack and stroke). The dose of statin therapy should be based on a person’s risk for cardiovascular disease. In addition, the ADA recommended a less strict goal for diastolic blood pressure—80 mmHg compared with 90 mmHg in the past. Diastolic blood pressure is the bottom number in a blood pressure measurement, and measures the pressure in your arteries in between heartbeats when your heart is at rest. Lower Diabetes Screening Cutoff for Asian Americans Many Asian Americans develop diabetes at a lower body weight because they tend to gain weight around their waist, which is linked to a greater risk for diabetes and cardiovascular disease compared with weight gain in thighs and other parts of the body. Because of this difference in weight gain, the ADA has lowered the recommended body mass index (BMI) for screening Asian Americans for diabetes from ≥25 kg/m2 (the cutoff for the general public) to ≥23 kg/m2. Body mass index is a measure of body fat based on a person’s weight and height. Blood Sugar Goals for Children and Adolescents All children and adolescents with diabetes should aim to reach a target Continue reading >>

New Diabetes Screening Recommendation Misses More Than Half Of High-risk Patients

New Diabetes Screening Recommendation Misses More Than Half Of High-risk Patients

Follow all of ScienceDaily's latest research news and top science headlines ! New diabetes screening recommendation misses more than half of high-risk patients Latest screening guidelines don't identify many patients with diabetes, prediabetes, say experts Fifty-five percent of high-risk patients were missed by diabetes screening guidelines, according to a new study. Not identifying patients with diabetes and prediabetes prevents them from getting the necessary preventive care. This is the first study to examine how the latest diabetes screening guidelines, issued in October 2015, may perform in practice. The latest government guidelines doctors follow to determine if patients should be screened for diabetes missed 55 percent of high-risk individuals with prediabetes or diabetes, a new Northwestern Medicine study found. The 2015 screening guidelines from the United States Preventive Service Task Force (USPSTF) recommend patients be screened for diabetes if they are between 40 and 70 years old and are overweight or obese. But the study found many patients outside those age and weight ranges develop diabetes, especially racial and ethnic minorities. Not identifying individuals with dysglycemia (prediabetes or diabetes) in these high-risk groups means they will miss out on taking preventive measures, such as eating right and exercising or taking medications. This is the first study to examine how the new USPSTF guidelines, issued in October, may perform in practice. Under a provision in the Affordable Care Act, all services recommended by the USPSTF must be fully covered by insurers. Therefore, a patient who falls outside the diabetes screening guidelines and requests a test may have to pay out of pocket. "Preventing and treating diabetes early is very important, especial Continue reading >>

2016 Screening Guidelinesvastly Widen Screening

2016 Screening Guidelinesvastly Widen Screening

2016 Screening Guidelines for Type 2 Diabetes The ADA and AACE just jointly released 2016 screening guidelines for Type 2 Diabetes; theycast a significantly wider net.They now recommend screening everyone over the age of 45. In addition, they are eliminatingthe term diabetic to describe a person living with diabetes. Dr. Linda Girgis, MD, family practitioner, talks about the impact the new guidelineswill have on medicine. In the US, about nine percent of the population (more than 29 million people) are living with diabetes. Of these, approximately 1.25 million have Type 1 Diabetes. For those with Type 2 Diabetes, many are unaware that they have the disease . Researchers estimate over 8 million people have diabetes and do not know it. Diabetes is more destructive over time. Untreated, it can lead to blindness, kidney failure, heart attacks and other vascular diseases. To prevent these complications, it is imperative it be diagnosed as early as possible. For years, the guidelines recommended screening patients who had certain risk factors including a family history of someone being diabetic, obesity, concomitant hypertension or hyperlipidedmia, or history of gestational diabetes, or delivering babies weighing over nine pounds. 2016 Screening GuidelinesVastly Widen Screening However, the ADA (American DiabetesAssociation) and the AACE (American Association of Clinical Endocrinologists) issued new recommendations for 2016 and are advising universal screening of all adults 45 years of age and older. While the rising incidence of diabetes parallels the upward trends in obesity incidence, many cases are now being diagnosed in people with normal BMIs (Body Mass Index). This is a departure from the recommendations of the past. The danger with diabetes is many patients are asymp Continue reading >>

Diabetes Mellitus In Pregnancy: Screening And Diagnosis

Diabetes Mellitus In Pregnancy: Screening And Diagnosis

INTRODUCTION Pregnancy is accompanied by insulin resistance, mediated primarily by placental secretion of diabetogenic hormones including growth hormone, corticotropin-releasing hormone, placental lactogen, and progesterone. These and other metabolic changes ensure that the fetus has an ample supply of nutrients. (See "Maternal adaptations to pregnancy: Endocrine and metabolic changes".) Gestational diabetes develops during pregnancy in women whose pancreatic function is insufficient to overcome the insulin resistance associated with the pregnant state. Among the main consequences are increased risks of preeclampsia, macrosomia, and cesarean delivery, and their associated morbidities. The approach to screening for and diagnosis of diabetes in pregnant women will be reviewed here. Management and prognosis are discussed separately: Continue reading >>

Prediabetes Screening And Treatment In Diabetes Prevention: The Impact Of Physician Attitudes

Prediabetes Screening And Treatment In Diabetes Prevention: The Impact Of Physician Attitudes

Abstract Purpose: Detection and treatment of prediabetes is an effective strategy in diabetes prevention. However, most patients with prediabetes are not identified. Our objective was to evaluate the relationship between attitudes toward prediabetes as a clinical construct and screening/treatment behaviors for diabetes prevention among US family physicians. Methods: An electronic survey of a national sample of academic family physicians (n 1248) was conducted in 2016. Attitude toward prediabetes was calculated using a summated scale assessing agreement with statements regarding prediabetes as a clinical construct. Perceived barriers to diabetes prevention, current strategies for diabetes prevention, and perceptions of peers were also examined. Results: Physicians who have a positive attitude toward prediabetes as a clinical construct are more likely to follow national guidelines for screening (58.4% vs 44.4; P < .0001) and recommend metformin to their patients for prediabetes (36.4% vs 20.9%; P < .0001). Physicians perceived a number of barriers to treatment, including a patient's economic resources (71.9%), sustaining patient motivation (83.2%), a patient's ability to modify his or her lifestyle (75.3%), and time to educate patient (75.3%) as barriers to diabetes prevention. Conclusions: How physicians view prediabetes varies significantly, and this variation is related to treatment/screening behaviors for diabetes prevention. Methods This study analyzed a survey conducted as part of the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA). CERA is a joint initiative of all 4 major US academic family medicine organizations (the Society of Teachers of Family Medicine, the North American Primary Care Research Group, the Association of Departmen Continue reading >>

Guidelines

Guidelines

There is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those living with the condition. Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefit. Reasons include the size and complexity of the evidence-base, and the complexity of diabetes care itself. One result is a lack of proven cost-effective resources for diabetes care. Another result is diversity of standards of clinical practice. Guidelines are part of the process which seeks to address those problems. IDF has produced a series of guidelines on different aspects of diabetes management, prevention and care. The new IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care seek to summarise current evidence around optimal management of people with type 2 diabetes. It is intended to be a decision support tool for general practitioners, hospital based clinicians and other primary health care clinicians working in diabetes. Pocket chart in the format of a Z-card with information for health professionals to identify, assess and treat diabetic foot patients earlier in the "window of presentation" between when neuropathy is diagnosed and prior to developing an ulcer. The content is derived from the IDF Clinical Practice Recommendations on the Diabetic Foot 2017. Available to download and to order in print format. The IDF Clinical Practice Recommendations on the Diabetic Foot are simplified, easy to digest guidelines to prioritize health care practitioner's early intervention of the diabetic foot with a sense of urgency through education. The main aims of the guidelines are to promote early detection and intervention; provide the criteria for Continue reading >>

Aace/ace Clinical Practice Guidelines

Aace/ace Clinical Practice Guidelines

American Association of Clinical Endocrinologists The American Association of Clinical Endocrinologists The Voice of Clinical Endocrinology Founded in 1991 Keep up to date with the latest in Legislative and Regulatory news AACE recognizes the importance of providing continued education to its members, which may require financial support from an outside entity through unrestricted educational grants. Outside support will not be used for the development and/or writing of AACE consensus statements/conference proceedings, white papers, or guidelines. Outside support may be accepted for the administration/ logistical support of a consensus conference and for the dissemination and distribution of the final written paper. The content of these documents is developed solely by AACE members and, as always, will remain free of any outside entity influence. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice are systematically developed statements to assist health care professionals in medical decision making for specific clinical conditions, but are in no way a substitute for a medical professional's independent judgment and should not be considered medical advice. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment of the authors was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with, and not a replacement for, their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines Continue reading >>

Managing Diabetes In Primary Care: 2016 Recommendations From Ada

Managing Diabetes In Primary Care: 2016 Recommendations From Ada

Managing diabetes in primary care: 2016 recommendations from ADA Managing diabetes in primary care: 2016 recommendations from ADA The American Diabetes Association (ADA) has released a summary of its 2016 recommendations that focus on managing patients with diabetes inprimary care, as published March 1 in the Annals of Internal Medicine. A synopsis of the 2016 Standards of Medical Care in Diabetes highlights 8 key areas for primary care providers: diagnosis, glycemic targets, medical management, hypoglycemia, cardiovascular risk factor management, microvascular disease screening and management, and inpatient diabetes management. To create the 2016 Standards, the ADA Professional Practice Committee (PPC) searched on MEDLINE to find and grade new evidence from January 1, 2015, through December 7, 2015. Recommendations are assigned an A, B, or C rating based on evidence quality. Some expert opinions are given an E rating to indicate that there is no evidence from clinical trials, clinical trials may be impractical, or existing evidence is conflicting. The 2016 ADA Standards diagnostic criteria for prediabetes and diabetes are outlined in Table 1. Table 1. Criteria for the diagnosis of prediabetes and diabetes1 * 2-h plasma glucose level after a 75-g oral glucose tolerance test ** In the absence of unequivocal hyperglycemia, results should be confirmed by repeated testing. *** Only diagnostic in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis. Distinguishing whether a patient has type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) is important, as their diagnosis affects management. T1DM is characterized by the presence of 1 or more autoimmune markers. Pregnant women with no history of diabetes should be screened for gestational diab Continue reading >>

Screening For Type Ii Diabetes Mellitus In The United States: The Present And The Future

Screening For Type Ii Diabetes Mellitus In The United States: The Present And The Future

Go to: Screening: Current Recommended Practices Screening is the process by which asymptomatic individuals who are at high risk of the disease are identified for further investigation.4 An fasting blood glucose (FBG) ≥ 126 mg/dL is diagnostic for diabetes and warrants retesting. A 75-g oral glucose tolerance test is also suitable and screening is positive with a 2-hour postload value of ≥200 mg/dL. Values ≥200 mg/dL are repeated on a different day to confirm diagnosis of diabetes. The A1c test is also a valuable tool for diagnosis of diabetes and A1c > 5.6 indicates impaired glucose tolerance.5 Genetic screening for diabetes is of little value in clinical practice.6 In United States, different societies and task forces have recommended varying guidelines for screening for Type 2 diabetes mellitus as presented in Table 1. Despite these guidelines for earlier screening, there are individuals who are not clinically diagnosed until at least a decade after subclinical disease.7 This is likely due to a combination of ineffective screening guidelines, inadequate implementation of the guidelines, and late presentation of disease. These guidelines, like all other screening tools in the medical community, are employed by many practitioners to target high-risk populations (Table 1). The United States Preventative Services Task Force (USPSTF) revised in its 2008 guidelines for screening in asymptomatic adults with sustained blood pressure > 135/80 or obese adults aged between 40 and 70 years.8,9 The American Diabetes Association (ADA) recommends screening based on body mass index (BMI) ≥ 25 kg/m2 in addition to risk factors. Individuals aged ≥45 years are recommended to be screened regardless of risk factors. Likewise, in children aged 10 years and older, ADA advocates fo Continue reading >>

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