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2017 Va Dod Diabetes Guidelines

Management Of Type 2 Diabetes: Va/dod Clinical Practice Guidelines

Management Of Type 2 Diabetes: Va/dod Clinical Practice Guidelines

Home CME & MOC Online Learning Center Management of Type 2 Diabetes: VA/DoD Clinical Practice Guidelines Management of Type 2 Diabetes: VA/DoD Clinical Practice Guidelines 1 CME/MOC Start Activity Log in for access In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus. The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. This synopsis summarizes key features of the guideline in 7 areas: patient-centered care and shared decision making, glycemic biomarkers, hemoglobin A1c target ranges, individualized treatment plans, outpatient pharmacologic treatment, glucose targets for critically ill patients, and treatment of hospitalized patients. Many articles published in the Annals of Internal Medicine (annals.org) offer CME credit and MOC points, earned by reading the articles and subsequently completing a multiple-choice quiz to demonstrate knowledge. Note that CME and MOC availability typically expires 3 years after article publication, but quizzes remain available to allow learners to test their knowledge. Continue reading >>

Va, Dod Develop Diabetes Clinical Practice Guidelines

Va, Dod Develop Diabetes Clinical Practice Guidelines

VA, DoD Develop Diabetes Clinical Practice Guidelines The US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) have released a joint clinical practice guideline for the management of type 2 diabetes mellitus. The guidelines were based upon a literature review conducted by a panel of multidisciplinary clinicians and the ECRI Institute, and emphasize personalizing treatment based upon evaluation of patient risk and the results of major trials. ____________________________________________________________________ Provide patient-centered care and incorporate shared decisions making Assess patient characteristics and nonglycemic factors when interpreting the results of hemoglobin A1c, fructosamine, and other biomarker testing Set HbA1c target ranges based on absolute reduction in risk for significant microvascular complications Select pharmaceutical agents based on efficacy, contraindications, drug interactions, and comorbidities In summary, the VA/DoD [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events, the authors concluded. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice. Conlin PR, Colburn J, Aron D, et al. Synopsis of the 2017 U.S. department of veterans affairs/U.S. department of defense clinical practice guideline: management of type 2 diabetes mellitus [published online October 24, 2017]. Ann Intern Med. doi:10.7326/M17 Continue reading >>

Medical Xpress: New Clinical Practice Guideline For Management Of T2dm

Medical Xpress: New Clinical Practice Guideline For Management Of T2dm

New clinical practice guideline for management of T2DM (HealthDay)Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online Oct. 23 in the Annals of Internal Medicine. Paul R. Conlin, M.D., from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes mellitus . The authors provided updates on management within seven areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of hemoglobin A1c (HbA1c), individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients , and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice," the authors write. Continue reading >>

Va, Dod Issue Type 2 Diabetes Clinical Practice Guideline

Va, Dod Issue Type 2 Diabetes Clinical Practice Guideline

VA, DoD Issue Type 2 Diabetes Clinical Practice Guideline According to a recent clinical practice guideline, the management of type 2 diabetes should include shared decision-making, individualized diabetes self-management education, and individualized glycemic management plans. The new clinical guidelines were published in Annals of Internal Medicine (online October 24, 2017; doi:10.7326/M17-1362). A group of researchers led by Paul R Conlin, MD, Veterans Affairs (VA) Boston Healthcare System (West Roxbury, MA), convened a joint US Department of VA and US Department of Defense (DoD) Evidence-Based Practice Work Group (April 2017) in an effort to create a guideline for the management of type 2 diabetes. The working group was comprised of multidisciplinary practicing stakeholders and submitted to the Institute of Medicines tenets for trustworthy clinical practice guidelines. Authors of the guideline agreed upon updates in management of type 2 diabetes in seven areas: patient-centered care and shared decision-making, glycemic biomarkers, target ranges of HbA1c, individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patient in the hospital. Key recommendations in the guideline include patients should be offered individualized diabetes self-management education, individualized glycemic management plans, and individualized target ranges for HbA1c. Continue reading >>

Va/dod Diabetes Guidelines Vary Significantly From Other Groups

Va/dod Diabetes Guidelines Vary Significantly From Other Groups

VA/DoD Diabetes Guidelines Vary Significantly From Other Groups By Brenda L. Mooney, MDalert.com Contributor Save to PDF December 20, 2017 By By Brenda L. Mooney, MDalert.com Contributor New clinical guidelines on diabetes were jointly published earlier this year by the Department of Veterans Affairs (VA) and the Department of Defense (DoD) and may be of great interest to health care providers outside of federal medicine. One reason is that the VAs Choice program is pushing an increasing amount of veteran care into the community, with the agency reporting it had authorized more than 15 million such appointments in the first six months of this year. Another is that the VA/DoD diabetes guidelines , which were published in the Annals of Internal Medicine, differ in some significant ways from those issued by the American Diabetes Association (ADA), the American Geriatric Society (AGS) and the American Association of Clinical Endocrinologists (AACE). Veteran with diabetes. (Source: U.S. Dept. of Veterans Affairs ) The VA/DoD clinical practice guidelines (CPG) address diabetes management in seven areas: patient-centered care and shared decision-making, glycemic biomarkers, target ranges of HbA1c, individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Among the key recommendations are that patients should be offered individualized diabetes self-management education, individualized glycemic management plans, and individualized target ranges for HbA1c. It makes few explicit recommendations on pharmacologic treatment, however, with one being the use of insulin for patients with significant symptoms, ketosis, type 1 diabetes or severe hyperglycemia. Gener Continue reading >>

Opioids For Chronic Pain: A New Clinical Guideline From The Va And Department Of Defense

Opioids For Chronic Pain: A New Clinical Guideline From The Va And Department Of Defense

Opioids for chronic pain: a new clinical guideline from the VA and Department of Defense Opioids for chronic pain: a new clinical guideline from the VA and Department of Defense The VA and DoD issued a clinical practice guideline regarding opioid therapy for chronic pain in veterans. A new clinical practice guideline regarding the use of opioids for chronic pain has been released by the Department of Veterans Affairs (VA) and Department of Defense (DoD). The evidence-based recommendations are intended for practitioners throughout the DoD and VA Health Care systems and were developed by the Opioid Therapy for Chronic Pain Work Group. The revised guideline serves as an update to the 2010 guideline by the VA and DoD. The guideline is intended to assist healthcare providers in all aspects of patient care, including, but not limited to, diagnosis, treatment, and follow-up, according to the work group. The system-wide goal of this guideline is to improve the patient's health and well-being by providing evidence-based guidance to providers who are taking care of patients on or being considered for long-term opioid therapy . The work group developed 18 recommendations and graded each as strong for or strong against, with the exception of the use of multimodal pain care in Recommendation 18, which was graded as weak for. A summary of the work group's recommendations is as follows: 1. Avoid initiation of long-term opioid therapy for chronic pain. Use alternatives to opioid therapy such as self-management strategies and other nonpharmacologic treatments. When pharmacologic therapies are used, initiate nonopioids over opioids. 2. If prescribing opioid therapy for patients with chronic pain, a short duration is recommended. Note: Consideration of opioid therapy beyond 90 days requi Continue reading >>

New Va, Dod Opioid Guideline Warns Against Long-term Use

New Va, Dod Opioid Guideline Warns Against Long-term Use

New VA, DoD Opioid Guideline Warns Against Long-Term Use When it comes to treating chronic pain with opioid therapy, clinicians should tread carefully, prescribe for only a short duration at the lowest dose possible, and have "thoughtful discussions" with their patients, according to a newly updated clinical practice guideline on opioids for chronic pain from the US Department of Veterans Affairs (VA) and the Department of Defense (DoD). In fact, its very first recommendation takes a "strongly against" stance regarding initiating long-term treatment with opioids for adult patients with chronic pain. Instead, it suggests nonpharmacologic or at least nonopioid treatments. The document also notes that benzodiazepines should not be used concurrently with opioid therapy; that risk mitigation is important; and that careful, individualized tapering should be implemented to reduced dosage or even discontinuation for those already receiving long-term therapy. However, James L. Sall, PhD, clinical quality program specialist at the VA Office of Quality, Safety and Value, reiterated to Medscape Medical News the importance of the #1 recommendation. "When it comes to opioids for chronic pain, just don't do it," said Dr Sall. "There's no absolute safe dose for opioids." Jack Rosenberg, MD, also from the VA and one of the two clinician experts appointed as "Guideline Champions," agreed, adding that it's important that clinicians not add harm to an already difficult situation. "The evidence for opioid therapy working is very minimal and the evidence for harm is substantial. This can be a life-long problem," he said. Although the new guideline is an update to one released in 2010, it's actually the third version. "The use of opioids has changed tremendously since the 1990s, when we firs Continue reading >>

Va, Dod Release New T2d Clinical Practice Guideline

Va, Dod Release New T2d Clinical Practice Guideline

VA, DoD Release New T2D Clinical Practice Guideline VA, DoD Release New T2D Clinical Practice Guideline With this update, the VA and the DoD hope to communicate the importance of personalized diabetes treatment to clinicians, patients, and policymakers. HealthDay News Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online in the Annals of Internal Medicine. Paul R. Conlin, MD, from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint US Department of Veterans Affairs (VA) and US Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes. The authors provided updates on management within 7 areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of HbA1c , individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. T2D Remission, Weigh Loss Associated With Roux-en-Y Surgery "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal proc Continue reading >>

Guideline Summary: Va/dod Clinical Practice Guideline For The Management Of Type 2 Diabetes Mellitus In Primary Care. [department Of Veterans Affairs]

Guideline Summary: Va/dod Clinical Practice Guideline For The Management Of Type 2 Diabetes Mellitus In Primary Care. [department Of Veterans Affairs]

Note from the Department of Veterans Affairs and the Department of Defense (VA/DoD) and the National Guideline Clearinghouse (NGC): The recommendations for the management of type 2 diabetes mellitus in the primary care setting are organized into 5 sections with 2 algorithms. The sections with accompanying recommendations are provided below. See the original guideline document for the algorithms and evidence tables with recommendations, including strength of recommendation, recommendation category, and supporting evidence citations. The strength of recommendation grading (Strong For, Weak For, Strong Against, Weak Against) and recommendation categories (Reviewed, Not reviewed, New-added, New-replaced, Not changed, Amended, Deleted) are defined at the end of the "Major Recommendations" field. General Approach to Type 2 Diabetes Mellitus Care The Work Group recommends shared decision-making to enhance patient knowledge and satisfaction. (Strong for; Reviewed, New-added) The Work Group recommends that all patients with diabetes should be offered ongoing individualized diabetes self-management education via various modalities tailored to their preferences, learning needs and abilities based on available resources. (Strong for; Reviewed, New-replaced) The Work Group suggests offering one or more types of bidirectional telehealth interventions (typically health communication via computer, telephone or other electronic means) involving licensed independent practitioners to patients selected by their primary care provider as an adjunct to usual patient care. (Weak for; Reviewed, New-replaced) The Work Group recommends setting a glycosylated hemoglobin (HbA1c) target range based on absolute risk reduction of significant microvascular complications, life expectancy, patient prefe Continue reading >>

Synopsis Of The 2017 U.s. Department Of Veterans Affairs/ U.s. Department Of Defense Clinical Practice Guideline: Management Of Type 2 Diabetes Mellitus

Synopsis Of The 2017 U.s. Department Of Veterans Affairs/ U.s. Department Of Defense Clinical Practice Guideline: Management Of Type 2 Diabetes Mellitus

N2 - Description: In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus. Methods: The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Recommendations: This synopsis summarizes key features of the guideline in 7 areas: patient-centered care and shared decision making, glycemic biomarkers, hemoglobin A1c target ranges, individualized treatment plans, outpatient pharmacologic treatment, glucose targets for critically ill patients, and treatment of hospitalized patients. AB - Description: In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus. Methods: The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016 Continue reading >>

Overview Of The 2017 Va/dod Clinical Practice Guideline For The Management Of Type 2 Diabetes

Overview Of The 2017 Va/dod Clinical Practice Guideline For The Management Of Type 2 Diabetes

Overview of the 2017 VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes The 2017 diabetes mellitus guidelines emphasize shared decision making, dietary changes, and HbA1c target range for optimal control of diabetes mellitus. Fed Pract. 2017 October;34(suppl 8):S14-S19 CDR Tschanz is an associate program director at Naval Medical Center San Diego in California. Dr. Watts is the VHA Office of Nursing Services metabolic syndrome & diabetes advisor at Louis Stokes Cleveland VA Medical Center in Ohio. Maj Colburn is a staff endocrinologist at San Antonio Military Medical Center in Texas. Dr. Conlin is chief of the medical service for the VA Boston Healthcare System in Massachusetts. Dr. Pogach is the national director of medicine for the VHA Office of Specialty Care Services. The authors report no actual or potential conflicts of interest with regard to this article. The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner , Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. Diabetes mellitus (DM) is an epidemic in the U.S. More than 30 million people (9.4% of the total population) have DM; type 2 DM (T2SM) accounts for 95% of these cases. 1 The estimated prevalence of DM among individuals aged > 65 years is about 3 times higher at 26%. The prevalence among veterans enrolled in the VA is higher than in the general population; about 25% of VA users have been diagnosed with DM. 2 As a result, DM is the leading cause of blindness, end stage renal disease, amputations, and a significant contributor to myocardial infarction and stroke. Older adults with DM have an increased risk of mortality compared with individuals without DM. 3 In 2012, DM was estimated to cost $ Continue reading >>

Synopsis Of The 2017 U.s. Department Of Veterans Affairs/u.s. Department Of Defense Clinical Practice Guideline: Management Of Type 2 Diabetes Mellitus Free

Synopsis Of The 2017 U.s. Department Of Veterans Affairs/u.s. Department Of Defense Clinical Practice Guideline: Management Of Type 2 Diabetes Mellitus Free

Abstract Description: In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus. Methods: The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Recommendations: This synopsis summarizes key features of the guideline in 7 areas: patient-centered care and shared decision making, glycemic biomarkers, hemoglobin A1c target ranges, individualized treatment plans, outpatient pharmacologic treatment, glucose targets for critically ill patients, and treatment of hospitalized patients. Diabetes is the leading cause of major complications, such as end-stage renal disease and lower extremity amputations, and is a significant contributor to ischemic heart disease, stroke, peripheral vascular disease, and vision loss (1). There has been increasing acceptance of the importance of individualizing glycemic management and assessment of risk for adverse events, especially hypoglycemia (2–6). This is of great importance for all patients, especially older adults (aged ≥65 years) with comorbid conditions. In 2013, 12.0 million older adults in the United States had diabetes, comprising 40% of the 30.2 million persons with the disease (7 Continue reading >>

Qmo - Diabetes

Qmo - Diabetes

Welcome to the Diabetes Mellitus CPG home page. Thank you for your continued support of Clinical Practice Guidelines Click here to join the VA/DoD Diabetes Specialty Group email distribution list. Simply hit send and your name will be added to the list. Link for Life is an interactive program on diabetes and heart disease (starring Type 2 Lou). The American Diabetes Association is proud to announce that Link for Life won a Gold Award from the World Wide Web Health Awards. Are you ready to learn how you can reduce your risk for heart attacks and stroke? Click here for a fun, interactive program filled with practical tips and valuable information. Click here for CDCs Health-E-Cards for you to send to your patients, friends, family or co-workers with Diabetes and to learn more about other CDE Health-E-Cards. Survival Skills Handouts for Patients - Individual sheets you can print and hand out to patients < option value="survival_skills_sheets/high_blood_sugar.pdf" selected="selected" >What is High Blood Sugar Information from the IHI on how to improve diabetes care, tools, measures and improvement stories. There are six fundamental areas identified by the Chronic Care Model making up a system that encourages high-quality chronic disease management. Organizations must focus on these six areas, as well as develop productive interactions between patients who take an active part in their care and providers backed up by resources and expertise. The changes described here can be applied to a variety of chronic illnesses, health care settings, and target populations. More. . . The Air Force Center of Excellence for Medical Multimedia has a diabetes online program called "Diabetes and You". This program is designed for anyone facing this condition. It has been developed to teach p Continue reading >>

Uniformed Services University

Uniformed Services University

Bachelor of Science in Biology 2001-2005 Representative publications, projects, and/or deployments 2016-2017 Co-Chairman on the committee for the Veterans Affairs/Department of Defense Clinical Practice Guidelines for the Management of Diabetes Mellitus 2017 Air Force Excellence in Clinical or Academic Teaching (MF) Special Experience Identifier (SEI) 1. P.R. Conlin, D.C. Aron, J.A. Colburn, E.M. Decesare, A.M.Lugo, S.A. Watts. Roundtable Discussion: Implementing the 2017 VA/DoD Diabetes Clinical Practice Guideline. 2017. Fed Pract. 34(8):10-15. 2. M.P. Tschanz, S.A. Watts, J.A. Colburn, P.R. Conlin, L.M. Pogach. Overview of the 2017 VA/DoD Clinical Practice Guideline For the Management of Type 2 Diabetes. 2017. Fed Pract. 34(8):4-9. 3. Conlin, P. R., Colburn, J., Aron, D., Pries, R., Tschanz, M. P., & Pogach, L. (2017). Synopsis of the 2017 u.s. department of veterans affairs/u.s. department of defense clinical practice guideline: Management of type 2 diabetes mellitus. Annals of Internal Medicine. doi:10.7326/M17-1362 5. Kluesner JK, Beckman DJ, Tate JM, Wardian JL, Graybill SD, Colburn JA, Folaron I, True MW. Analysis of Current Thyroid Function Test Ordering Practices. 2017. Journal of Evaluation in Clinical Practice. PMID 29105255 6. Tate JM, Colburn JA, Gyorffy JB. The rationale for pheochromocytoma screening in patients with neurofibromatosis type 1: a case report and review of literature. 2017. SAGE Open Medical Case Reports. 5: 1-4. 7. Colburn J.A., Pogach L., Conlin P.R., Good C.B., Aron D.C., Mercedes F., Julius M., Pries R., Khachikian D., Watts S.A., Lugo A.M., Atayde E.R., McReynolds S., Steil E.N., Snyder T., Stuffel E.P., Thompson G.H., Tschanz M.P., Watson N.A. VA/DoD clinical practice guideline for the management of type 2 diabetes mellitus in primary Continue reading >>

Behavioral Health Clinical Practice Guidelines 2017-2018

Behavioral Health Clinical Practice Guidelines 2017-2018

(2008) American Academy of Child and Adolescent Psychiatry The Behavioral Health Care Management Programs offered by BCBSNM serve members suffering from Depression, Alcohol/Substance Abuse Disorders, Anxiety/Panic Disorders, Attention Deficit/Hyperactivity Disorder, Bipolar Disorder, Eating Disorders, Schizophrenia, and other Psychotic Disorders. If a professional provider has a patient who may benefit from participating in one of the above mentioned programs, please call Behavioral Health Member Services using the number on the back of the members ID card to have the patient screened and considered for enrollment in a Case Management Program. The Behavioral Health Clinical Practice Guidelines are applicable to all BCBSNM BH product lines including Blue Cross Community CentennialSM. These guidelines are designed to assist clinicians by providing a framework for evaluation and treatment of patients and is not intended to either replace a clinicians judgement or establish a protocol for all patients with a particular condition. Guidelines for the use of Psychotropic Medication Management are included within each Behavioral Health Clinical Practice Guideline. Such services are funded in part with the State of New Mexico. Continue reading >>

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