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2017 Standards Of Medical Care In Diabetes

New Standards Of Medical Care In Diabetes 2017

New Standards Of Medical Care In Diabetes 2017

Every year the American Diabetes Association updates its recommendations for “Standards of Medical Care in Diabetes.” The ADA has been involved in the development of these standards for more than 20 years. While the entire document is 142 pages I will provide highlights of that document in 200 words or less! Here are some of the changes for 2017: It is now recommended that sleep pattern assessment be part of a comprehensive medical exam based on evidence suggesting a relationship between sleep quality and blood sugar control. No more than 30 minutes of sitting! For those people who are sitting for long periods of time it is recommended to interrupt that sitting every 30 minutes with short bouts of activity. Another recommendation highlights the importance of flexibility training in older adults. Carb counting, protein counting and fat counting … In addition to the recommendation of counting carbohydrates in the diet for those people who use mealtime insulin, the new recommendation includes counting fat and protein. Evidence shows that these also influence insulin dosing and blood glucose levels. Early screening for diabetes The importance of recognizing people who are at risk for diabetes cannot be overemphasized. Providers are encouraged to use assessment tools to identify those at risk early and to identify those people with undiagnosed prediabetes and diabetes. Psychosocial issues The recommendations now also include the relevance of psychosocial issues in all aspects of diabetes care, including self-management, mental health, communication, complications, co-morbidities and life-stage considerations. Additional recommendations also highlight the importance of assessment and referral for psychosocial issues in youth with diabetes. For more information on the 20 Continue reading >>

How Does Healthcare Work In Your Country?

How Does Healthcare Work In Your Country?

Brazil Health is a Constitutional right since 1988 (our current valid Constitution). It is stated right there, something in the lines of “Health is a universal right and a (federal) State's duty". (1) The same article goes on, stating that the State (government) must provide universal access to health care, with actions of promotion, protection and restoration of health. Really strong and impressive! It took a couple of years to really be implemented, so it can be said that 1990 Brazil has the “Sistema Único de Saúde (SUS)” - National Health System, translated literally as a "single system of health”. Its name implies a restrictive or unitary access, such as only having public funding, but this understanding is (fortunately, you could say) misguided. We have a mixed system, combining private and public access. So, for naming purposes, when a Brazilian uses public health care, we say one is using SUS. And 7 out of 10 Brazilians rely exclusively on SUS (2). As most things regarding politics, there are a lot of bureaucracies and theoretical definitions for SUS. During Med School, I had more than 2 years of studying health polices and its intricacies. Suffice it is to say that when I graduated, I was really fond of the system, but after almost five years of working as a Physician this admiration has dramatically dropped. The math does not add up. Let's discuss some fictional scenarios, I'll give people random names for the sake of illustration: João, blue-collar worker, 48 years of age, has recently been diagnosed with hypertension. He was started on some anti-hypertensive medication by his SUS’ primary care physician. Wonderfully, he has all of that for free. Yes, he did not have to spend any (extra) money to see the doctor or even to buy medicines. It's all p 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 >>

2017 Standards Of Medical Care In Diabetes Released

2017 Standards Of Medical Care In Diabetes Released

TUESDAY, Sept. 12, 2017 (HealthDay News) -- Recommendations for the management and pharmacologic treatment of patients with diabetes have been updated; the new clinical guidelines were published online Sept. 12 in the Annals of Internal Medicine. James J. Chamberlain, M.D., from St. Mark's Hospital in Salt Lake City, and colleagues updated the Standards of Medical Care in Diabetes to provide evidence-based recommendations for the diagnosis and management of patients with diabetes. The American Diabetes Association Professional Practice Committee searched the literature to add, clarify, or revise recommendations based on new evidence and rated the recommendations depending on the quality of evidence. The researchers recommend that most patients receiving intensive insulin regimens should self-monitor blood glucose before meals and snacks, at bedtime, after meals (occasionally), when they suspect low blood glucose, and before exercise and critical tasks such as driving. Continuous glucose monitoring is a useful tool to lower hemoglobin A1c (HbA1c) in selected adults with type 1 diabetes in conjunction with intensive insulin regimens. For nonpregnant adults, a reasonable HbA1c goal is less than 7 percent; more stringent goals might be suggested for selected individuals if they can be achieved without clinically significant hypoglycemia or other adverse effects. Recommendations were also provided for pharmacologic therapy for type 1 diabetes. "This synopsis focuses on recommendations from the 2017 Standards of Care about monitoring and pharmacologic approaches to glycemic management for type 1 diabetes," the authors write. Several authors disclosed financial ties to the biopharmaceutical industry. Abstract/Full Text This article: Copyright © 2017 HealthDay. All rights rese Continue reading >>

2017 Diabetes Care Standards Issued

2017 Diabetes Care Standards Issued

The American Diabetes Association has released its 2017 "Standards of Medical Care in Diabetes." An overview of the group's guidance on pharmacologic therapy for type 2 diabetes is available in the Annals of Internal Medicine. Among the recommendations: Metformin is still the preferred first-line regimen and should be prescribed for most patients at the time of diagnosis, provided it's not contraindicated. Starting at 500 mg once or twice daily may help minimize gastrointestinal side effects, followed by gradual titration up to 2 g/daily. If metformin is contraindicated or poorly tolerated, clinicians should use a patient-centered approach to choose from the other available agents. Tables detailing all FDA-approved diabetes medications, including their costs, are provided. Dual therapy should be considered for asymptomatic patients with hemoglobin A1c levels of 9% or greater. Insulin may be advisable for symptomatic patients or those with an HbA1c of 10% or greater or blood glucose of 300 mg/dL or greater. Continue reading >>

Ada Releases 2017 Standards Of Medical Care In Diabetes

Ada Releases 2017 Standards Of Medical Care In Diabetes

The American Diabetes Association has released it’s 2017 Standards of Medical Care in Diabetes. The Standards of Care are comprised of a committee of a dozen leading experts in diabetes care who annually review all the available research on diabetes and then rate recommendations based on that evidence-based clinical support. The guidelines focus on screening, diagnosis and treatment in order to help improve outcomes for people of all ages with type 1 or type 2 diabetes including women with gestational diabetes and the prevention and delay of type 2 diabetes development. The 2017 Standards of Medical Care in Diabetes highlight several issues including psychosocial care, physical fitness, metabolic surgery, and low blood sugar. Robert E Ratner, MD, FACP, FACE, the ADA’s Chief Scientific and Medical Officer said in the Association’s press release that this year’s Standards lead a multifaceted approach to give a “comprehensive, individualized diabetes care plan” for people with diabetes. 2017 Standards of Care Highlights More Attention to Psychological Health and Comorbidities Due to the heavy psychological and emotional burden from diabetes, the 2017 Standards have included guidelines on screening patients with diabetes for “diabetes distress”, depression, anxiety, and eating disorders. They have also included a list of situations that should prompt mental health specialist referral for the patient. Assessing comorbidities, which are conditions a patient lives with aside from their diabetes is recommended as part of a “comprehensive patient-centered evaluation. The list of comorbidities has been modified to now include autoimmune disease, HIV, anxiety disorders, depression, disordered eating behavior, and serious mental illness. Lifestyle Management The 2 Continue reading >>

2017 Ada Standards Of Medical Care, 2017: The Pharmacist’s Version

2017 Ada Standards Of Medical Care, 2017: The Pharmacist’s Version

As it happens every December, I look forward to receiving an email about the updated Standards of Medical Care for Diabetes, published by the American Diabetes Association. It is always a good read to learn the minor and/or major revisions to recommendations in order to educate healthcare professionals and implement into clinical practice at the start of the new year. This year, there are some tweaks within the guidelines. As a pharmacist, I wanted to provide a brief review regarding pharmacotherapy updates in the 2017 guidelines, especially for those who are not able to listen to the upcoming AADE webinar on January 26. Learn more. In the meantime, here are the highlights of the ADA Standards of Medical Care for Diabetes regarding pharmacotherapy with additional notes: There is published literature regarding the link between long-term metformin therapy and vitamin B12 deficiency. In the 2017 ADA guidelines, periodic monitoring of vitamin B 12 measurements is recommended for individuals taking metformin over a long period of time. If vitamin B12 deficiency is present, then supplementation is warranted. 2017 may be the year of biosimilar products, as these agents have been approved by the Food and Drug Administration. Biosimilar products are very similar to a reference product and they are not clinically different in regards to efficacy and safety. The 2017 ADA guidelines have added a new section regarding biosimilar insulin, as Lilly’s product – Basalglar –recently became available for use. Due to recent evidence on cardiovascular outcomes, empagliflizon and liraglutide are recommended for use among people with established cardiovascular disease. Both of these agents are shown to reduce the risk of mortality and may be a preferred option in this specific patient p 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 >>

Ada 2017 Standards Of Medical Care In Diabetes_dr Selim

Ada 2017 Standards Of Medical Care In Diabetes_dr Selim

1. Standards of Medical Care in Diabetes - 2017 Dr Shahjada Selim Assistant Professor Department of Endocrinology Bangabandhu Sheikh Mujib Medical University, Dhaka Email: [email protected], [email protected] 2. Standards of Care • Funded out Association’s general revenues and does not use industry support. • Slides correspond with sections within the Standards of Medical Care in Diabetes - 2017. • Reviewed and approved by the Association’s Board of Directors. 3. Process • ADA’s Professional Practice Committee (PPC) conducts annual review & revision. • Searched Medline for human studies related to each subsection and published since January 1, 2016. • Recommendations revised per new evidence, for clarity, or to better match text to strength of evidence. Professional.diabetes.org/SOC 4. Professional Practice Committee Members of the PPC •William H. Herman, MD, MPH (Co-Chair) •Rita R. Kalyani, MD, MHS, FACP (Co-Chair) •Andrea L. Cherrington, MD, MPH •Donald R. Coustan, MD •Ian de Boer, MD, MS •Robert James Dudl, MD •Hope Feldman, CRNP, FNP-BC •Hermes J. Florez, MD, PhD, MPH •Suneil Koliwad, MD, PhD •Melinda Maryniuk, MEd, RD, CDE •Joshua J. Neumiller, PharmD, CDE, FASCP •Joseph Wolfsdorf, MB, BCh ADA Staff •Erika Gebel Berg, PhD •Sheri Colberg-Ochs, PhD •Alicia H. McAuliffe-Fogarty, PhD, CPsycol •Sacha Uelmen, RDN, CDE •Robert E. Ratner, MD, FACP, FACE 5. Evidence Grading System 6. 1. Promoting Health and Reducing Disparities in Populations 7. Key Recommendations • Treatment decisions should be timely and based on evidence-based guidelines that are tailored to patient preferences, prognoses, and comorbidities. B • Providers should consider the burden of treatment and self-efficacy of patients when recommen Continue reading >>

Ada Releases 2018 Standards Of Care For Diabetes

Ada Releases 2018 Standards Of Care For Diabetes

The American Diabetes Association (ADA) has released their annual Standards of Medical Care in Diabetes for 2018, highlighting several updated recommendations for diabetes care and management. Based on current research findings, the standards offer comprehensive practice evidence-based recommendations. The updated guidelines address the use of the medications with potential cardiovascular (CV) benefit. Other areas addressed include diabetes screening, technology, and A1C tests. Some of the most notable changes are summarized below. Cardiovascular Disease and Diabetes New guidelines incorporate the use of diabetes drugs with known cardiovascular benefit. For adults with type 2 diabetes and heart disease, the ADA recommends that, after lifestyle management and metformin, health care providers should include a medication proven to improve heart health. In the clip below, Dhiren Patel, PharmD, discusses the importance of the new recommendations for diabetes care, including the use of diabetes medications with CV risk. All hypertensive patients with diabetes are encouraged to monitor their blood pressure at home to help identify potential discrepancies between office vs. home blood pressure, and to improve medication-taking behavior, according to the guidelines. The new ADA standards also continue with the existing hypertension definition, as opposed to the American College of Cardiology’s recently updated blood pressure guidelines. The ADA’s guidelines state that most adults with diabetes and hypertension should have a target blood pressure of <140/90 mmHg and that risk-based individualization lowers targets, such as 130/80 mmHg, may be appropriate in some patients. In the clip below, Dhiren Patel, PharmD, discusses the importance of the new recommendations for diabetes Continue reading >>

Standards Of Medical Care In Diabetes, 2017: What’s New?

Standards Of Medical Care In Diabetes, 2017: What’s New?

Every January, the American Diabetes Associations issues its Standards of Medical Care in Diabetes. These are guidelines that help your healthcare team provide you with the best diabetes care, and help you better manage your own diabetes. What’s new or different for 2017? Let’s take a look. Promoting Health and Reducing Disparities in Populations This section is called “Strategies for Improving Care,” and is about the importance of “patient-centered care,” or care that is respectful of your own preferences, needs, and values. What it means for you: When providing care, your healthcare team needs to be aware of possible social and lifestyle issues, like food insecurity (access to enough food), housing issues, and financial barriers (can’t afford health insurance). Your healthcare team should take all these into consideration when developing your treatment plan. When needed, you should be referred to support services within your community. You might also get diabetes self-management support from community health workers or coaches, especially if you live in an underserved community. Classification and Diagnosis of Diabetes In type 1 diabetes, blood glucose and A1C levels increase before the symptoms of type 1 diabetes appear. The American Diabetes Association recognizes three different stages of type 1 diabetes: stage 1, stage 2, and stage 3. What it means for you: If you have or are at risk for type 1 diabetes, your healthcare provider might be able to determine what stage of type 1 you have. This helps decide the best treatment options for you. Research is being done to identify treatments for stage 1 or 2 of type 1 diabetes. Comprehensive Medical Evaluation and Assessment of Comorbidities This section includes guidelines for provider-patient communication Continue reading >>

Pharmacologic Therapy For Type 2 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Pharmacologic Therapy For Type 2 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Abstract Description: The American Diabetes Association (ADA) annually updates the Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. Methods: For the 2017 Standards, the ADA Professional Practice Committee updated previous MEDLINE searches performed from 1 January 2016 to November 2016 to add, clarify, or revise recommendations based on new evidence. The committee rates the recommendations as A, B, or C, depending on the quality of evidence, or E for 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 informed revisions. Recommendations: This synopsis focuses on recommendations from the 2017 Standards about pharmacologic approaches to glycemic treatment of type 2 diabetes. The American Diabetes Association (ADA) first released its Standards of Medical Care in Diabetes for health professionals in 1989. These practice guidelines provide an extensive set of evidence-based recommendations that are updated annually for the diagnosis and management of patients with diabetes. The 2017 Standards cover all aspects of patient care (1); this guideline synopsis focuses on pharmacologic approaches for patients with type 2 diabetes. Pharmacologic Therapy for Type 2 Diabetes: Recommendations Initial Treatment Approach: Metformin Assessing Response and Deciding to Intensify Therapy Recent Evidence From Cardiovascular Outcomes Trials Recent Warnings About Pharmacotherapies Insulin Therapy Continue reading >>

2017 Standards Of Medical Care In Diabetes (part 1)

2017 Standards Of Medical Care In Diabetes (part 1)

By Eileen B. Wyner, NP Bulfinch Medical Group The American Diabetes Association (ADA) publishes guidelines each January to educate professionals about the best clinical practice for people diabetes. I will review the standards that have had changes made in them for 2017. Section 8 (Pharmacologic Approaches to Glycemic Treatment) is a very important section with a great deal of information, so it will be covered in a separate post. This year the Standards of Care have been updated to address psychosocial issues in all aspects of care. This includes the importance of assessing self-management capabilities, mental health status, and complications and comorbidities. These standards are meant to provide general treatment goals and are not meant to replace clinical judgment. This post is a brief overview of the changes to the standards; click here to access a full list and descriptions. Please remember, that these are in no way meant to replace the individual care that you are participating in with your health care team. Section 2: Classification and Diagnosis of Diabetes There is a new consensus on staging Type 1 Diabetes. Three stages have been identified: Stage 1 – no changes in the blood glucose values and no symptoms are present Stage 2 – some impaired fasting blood glucose and possibly some impaired glucose tolerance, too Stage 3 – the stage that most people are diagnosed. They may appear with dangerous hyperglycemia and have symptoms such as excessive thirst, hunger and urination Investigators hope to use this staging system as a research road map to help better plan intervention strategies. A new risk test has been developed to help to identify people with prediabetes and undiagnosed diabetes as soon as possible. Click here to see the test and share with loved o Continue reading >>

Highlights From The American Diabetes Association's 2017 Standards Of Medical Care In Diabetes For Osteopathic Physicians

Highlights From The American Diabetes Association's 2017 Standards Of Medical Care In Diabetes For Osteopathic Physicians

The American Diabetes Association (ADA) updates its Standards of Medical Care (SOMC) in Diabetes annually. These ADA standards make up a comprehensive document that serves as an excellent resource for clinical care. The current article comes from the ADA's Primary Care Advisory Group. This article highlights key aspects of the SOMC that are relevant to the day-to-day practice of osteopathic primary care physicians. It is not intended to replace the full SOMC but will refer to the master document for further explanation and evidence-based support. Continue reading >>

Standards Of Medical Care In Diabetes—2017

Standards Of Medical Care In Diabetes—2017

GENERAL CHANGES In light of the American Diabetes Association’s (ADA’s) new position statement on psychosocial care in the treatment of diabetes, the “Standards of Medical Care in Diabetes,” referred to as the “Standards of Care,” has been updated to address psychosocial issues in all aspects of care including self-management, mental health, communication, complications, comorbidities, and life-stage considerations. Although levels of evidence for several recommendations have been updated, these changes are not addressed below as the clinical recommendations have remained the same. Changes in evidence level from, for example, E to C are not noted below. The 2017 Standards of Care contains, in addition to many minor changes that clarify recommendations or reflect new evidence, the following more substantive revisions. SECTION CHANGES This section was renamed and now focuses on improving outcomes and reducing disparities in populations with diabetes. Recommendations were added to assess patients’ social context as well as refer to local community resources and provide self-management support. Section 2. Classification and Diagnosis of Diabetes The section was updated to include a new consensus on the staging of type 1 diabetes (Table 2.1) and a discussion of a proposed unifying diabetes classification scheme that focuses on β-cell dysfunction and disease stage as indicated by glucose status. Language was added to clarify screening and testing for diabetes. Screening approaches were described, and Fig. 2.1 was included to provide an example of a validated tool to screen for prediabetes and previously undiagnosed type 2 diabetes. Due to recent data, delivering a baby weighing 9 lb or more is no longer listed as an independent risk factor for the development o Continue reading >>

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