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Ada A1c Goals

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 >>

Controlling Diabetes: Teaching Patients To Take Charge

Controlling Diabetes: Teaching Patients To Take Charge

Thomas L. Lenz, PharmD, MA, PAPHS; Michael S. Monaghan, PharmD, BCPS; Alan W.Y. Chock, PharmD; and Julie A. Stading, PharmD, CDE The American Diabetes Association recommends that health care providers incorporate an estimated average glucose measurement when counseling patients with diabetes. The prevalence of diabetes mellitus is rising to epidemic proportions worldwide. Diabetes is now one of the top 5 causes of death in developed countries and the seventh leading cause of death in the United States.1,2 The risk of mortality in patients with diabetes is twice as high as in those without diabetes. Recent data indicate that the United States falls short of the desired goals for disease control.3 Pharmacists are well positioned within the community to educate patients with diabetes—and to help them reach their treatment goals to reduce diabetes morbidity and mortality. Recently, the American Diabetes Association (ADA) published a new recommendation for health care providers that will assist them in educating and reeducating patients on the importance of glycemic control and the seriousness of diabetes.4 The ADA now suggests that health care providers incorporate an estimated average glucose (eAG) measurement as a new term when educating patients with diabetes.4 Pharmacists should understand and delineate how this measurement may be used to educate patients with diabetes to help them achieve treatment goals. Current Methods of Monitoring Diabetes The ADA recommends self-monitoring of blood glucose (SMBG) and hemoglobin A1C (A1C) measurements as the 2 main strategies for monitoring glycemic control.5 SMBG is performed by patients themselves via a glucometer for the day-to-day management of blood glucose levels. The results of SMBG are presented in unit measurements as ei Continue reading >>

The Sweet Spots Study: A Real-world Interpretation Of The 2012 American Diabetes Association Position Statement Regarding Individualized A1c Targets

The Sweet Spots Study: A Real-world Interpretation Of The 2012 American Diabetes Association Position Statement Regarding Individualized A1c Targets

Go to: Abstract To evaluate awareness of the 2012 American Diabetes Association (ADA) Position Statement among physicians and assess its effects on patient-centered glycated hemoglobin (A1C) goals in the management of type 2 diabetes (T2D). The Summarizing Real-World Individualized TrEatmEnT GoalS and Potential SuppOrT Systems in Type 2 Diabetes (SWEET SPOTS) study used the HealthCore claims database to identify T2D patients, stratified by risk, and their treating physicians to assess primary care physician and endocrinologist awareness of the 2012 ADA Position Statement. Physicians completed online surveys on A1C targets before and after receiving an educational intervention to review the position statement. Of 125 responding physicians (mean age 50.3 years, 12.8% endocrinologists) who were linked to 125 patient profiles (mean age 56.9 years, 42% female, mean A1C 7.2%), 92% were at least somewhat aware of the position statement prior to the intervention and 59% believed that the statement would impact how they set A1C targets. The educational intervention resulted in mostly less stringent goal setting for both lower and higher risk patients, but changes were not significant. The proportion of physician-assigned A1C targets within ADA-recommended ranges increased from 56% to 66% post-intervention (P<0.0001). Physicians treating T2D are aware of the 2012 ADA Position Statement and believe that it may influence treatment goals. While patient-specific A1C targets were not significantly impacted, physicians indicated that they would make targets more or less stringent for lower and higher risk patients, respectively, across their practice. Further research into optimizing physician education regarding individualized A1C targets is warranted. Keywords: type 2 diabetes, Healt Continue reading >>

Management Of Blood Glucose With Noninsulin Therapies In Type 2 Diabetes

Management Of Blood Glucose With Noninsulin Therapies In Type 2 Diabetes

A comprehensive, collaborative approach is necessary for optimal treatment of patients with type 2 diabetes mellitus. Treatment guidelines focus on nutrition, exercise, and pharmacologic therapies to prevent and manage complications. Patients with prediabetes or new-onset diabetes should receive individualized medical nutrition therapy, preferably from a registered dietitian, as needed to achieve treatment goals. Patients should be treated initially with metformin because it is the only medication shown in randomized controlled trials to reduce mortality and complications. Additional medications such as sulfonylureas, dipeptidyl-peptidase-4 inhibitors, thiazolidinediones, and glucagon-like peptide-1 receptor agonists should be added as needed in a patient-centered fashion. However, there is no evidence that any of these medications reduce the risk of diabetes-related complications, cardiovascular mortality, or all-cause mortality. There is insufficient evidence on which combination of hypoglycemic agents best improves health outcomes before escalating to insulin therapy. The American Diabetes Association recommends an A1C goal of less than 7% for many nonpregnant adults, with the option of a less stringent goal of less than 8% for patients with short life expectancy, cardiovascular risk factors, or long-standing diabetes. Randomized trials in middle-aged patients with cardiovascular risk factors have shown no mortality benefit and in some cases increased mortality with more stringent A1C targets. Clinical recommendation Evidence rating References Metformin should be used as first-line therapy to reduce microvascular complications, assist in weight management, reduce the risk of cardiovascular events, and reduce the risk of mortality in patients with type 2 diabetes mell Continue reading >>

When It Comes To A1c Blood Test For Diabetics, One Level No Longer Fits All

When It Comes To A1c Blood Test For Diabetics, One Level No Longer Fits All

If there's one thing that people with diabetes get pounded into their heads, it's that they've got to keep their A1C level under control. That's the blood glucose measure that's used to decide how well a person is managing their diabetes. But new diabetes management guidelines announced today will cut many people with diabetes some slack. Where old guidelines from the American Diabetes Association said that people should maintain an A1C of 7, the new guidelines say that patients should work with their doctors to determine an appropriate A1C target. Practically speaking, this means that younger, newly diagnosed people with type II diabetes may need to aim for 7 or 6, while older people who also have heart disease may be OK at 8. The new position statement from the ADA and the European Association for the Study of Diabetes was published in the journal Diabetes Care. The A1C test is typcially done in a laboratory; home glucose monitors use a different number scale. (Though home A1C tests are on the market, too.) "It it unrealistic to expect that everybody with diabetes should have the same goals and use the same medication," Vivian Fonseca, president of the American Diabetes Association, told NPR's Allison Aubrey. "For some people who are relatively healthy with newly diagnosed diabetes who have no other problems, then a goal of lower than 7 percent may be appropriate." Most practicing physicians already knew that blood glucose management needed to be tailored to the patient, according to MaryAnn Banerji, director of the diabetes center at SUNY Downstate Medical Center. These new guidelines give patients and doctors permission to focus on coming up with the right combination of medication, diet, exercise, and glucose testing. "It was a misguided public health concept that Continue reading >>

Standards Of Medical Care

Standards Of Medical Care

“Standards of Medical Care in Diabetes—2015†comprises all of the current and key clinical practice recommendations of the American Diabetes Association (ADA) These Standards of Care are revised annually by the ADA’s multidisciplinary Professional Practice Committee (PPC) For the current revision, PPC members systematically searched Medline for human studies related to each subsection and published since 1 January 2014 Recommendations were revised based on new evidence or, in some cases, to clarify the prior recommendations or match the strength of the word to the strength of the evident A table linking the changes in the recommendations to new evidence can be reviewed at As for all position statements, the Standards of Care were reviewed and approved by the Executive Committee of ADA’s Board of Directors, which includes health care professionals, scientists, and lay people Feedback from the larger clinical community was valuable for the 2014 revision of the Standards of Care; readers who wish to comment on the “Standards of Medical Care in Diabetes—2015†are invited to do so at ADA funds development of the Standards of Care and all ADA position statements out of its general revenues and does not use industry support for these purposes The slides are organized to correspond with sections within the “Standards of Medical Care in Diabetes—2015†While not every section in the document is represented, these slides do incorporate the most salient points from the Position Statement * Reference American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care 2014;37(suppl 1):S1 Continue reading >>

Are We Meeting The American Diabetes Association Goals For Hiv-infected Patients With Diabetes Mellitus?

Are We Meeting The American Diabetes Association Goals For Hiv-infected Patients With Diabetes Mellitus?

Diabetes mellitus is a leading cause of morbidity in the United States, affecting 8% of the US adult population [1]. Insulin resistance is reported in 25%-30% of human immunodeficiency virus (HIV)-infected patients, and the incidence of diabetes mellitus among this population is estimated to be 2%-8% [2-4]. In the Data Collection on Adverse Events of Anti-HIV Drugs Study, the baseline prevalence of diabetes mellitus was 2.85%, with an incidence rate of 5.72 cases per 1000 person-years [5]. Cohort studies report that patients infected with HIV are up to 4 times more likely to develop diabetes mellitus than is the general population [4, 5]. Caring for patients with diabetes mellitus is complex and often requires a multidisciplinary approach. HIV practitioners at our center provide comprehensive primary care for their patients. Although data exist on the association between insulin resistance, diabetes, and highly active antiretroviral therapy (HAART), we found only 1 report on the management of diabetes mellitus in 40 HIV-infected patients [6]. The objective of this study was to determine rates of achieving the American Diabetes Association (ADA) goals among HIV-infected diabetic patients receiving primary care in a large, urban HIV clinic. Methods. This was a retrospective study conducted from January through April 2008 at the Ruth M. Rothstein CORE Center (Chicago, Illinois). The Institutional Review Board of the Cook County Bureau of Health Services approved the study. The CORE Center provides care to >4500 HIV-infected patients, the majority of whom are uninsured. Patients with diabetes mellitus were identified from the clinic database if they had 1 of the following criterion: an International Classification of Diseases, Ninth Revision diagnosis of diabetes mellitus, Continue reading >>

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 >>

Goals Of Treatment

Goals Of Treatment

Blood sugar control means knowing a few important numbers. The ADA recommends that your glucose levels be: Before Meal 70–130 mg/dl After Meal < 180 mg/dl Goals Of Diabetes Treatment To keep the blood sugar as normal as possible without serious high or low blood sugars Normal ranges for blood sugar People who don’t have diabetes keep their blood sugars between 60 – 100 mg/dl overnight and before meals, and less than 140 mg/dl after meals. Although the ultimate goal of diabetes management is to return the blood sugar to the natural or non-diabetic level, this may be difficult without excessive low blood sugars or hypoglycemia. What are the blood sugar (glucose) targets for diabetes? The ultimate treatment goal for Type 1 diabetes is to re-create normal (non-diabetic) or NEARLY normal blood sugar levels – without causing low blood sugars. Good blood sugar control requires that you know and understand a few general numbers. The numbers measure how much glucose is in your blood at certain times of the day and represent what the American Diabetic Association believes are the best ranges to prevent complications. American Diabetes Association Recommendations A1c* < 7.0% Before Meal Glucose Level 70-130 mg/dl After Meal Glucose Level < 180 mg/dl *Hemoglobin (A1c) is a measure of your average blood glucose control over the previous 3 months. Think of the A1c as a long-term blood glucose measure that changes very gradually. For example: When you have type 1 diabetes you are treated with insulin replacement therapy. The goal is to replace the insulin in the right amount and at the right time. Sometimes, more insulin than needed is taken and this will cause hypoglycemia. To minimize this risk, many providers will recommend that individuals treated with insulin target a pre Continue reading >>

A1c Test Goals

A1c Test Goals

The A1C test measures the percentage of hemoglobin A1C cells in a person's body have glucose attached to them. The test is used as a way to look at blood glucose control over a period of a few months. You can find out more about this in our Average blood glucose and the A1C test article. A person who doesn't have diabetes is likely to have an A1C test result of 5.7% or lower, meaning about 5% of the hemoglobin A1C molecules have blood sugar attached to them.1 However, without proper treatment, people with diabetes can have A1C results that are much higher than that. If you have diabetes, the American Diabetes Association (ADA) recommends A1C test results of less than 7%—and a tighter goal of 6.5% may be appropriate for some people.2 Benefits of lowering your A1C test result Now for the good news—keeping your A1C test results low can significantly reduce the risk of long-term diabetes complications such as nerve problems, damage to your eyes, damage, kidney disease and heart problems.3 If your A1C blood test result is higher than recommended, it's important to take steps to improve control. Talk to your healthcare team for suggestions and support. Continue reading >>

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

Treatment Of Type 2 Diabetes Mellitus In The Older Patient

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — The prevalence of type 2 diabetes continues to increase steadily as more people live longer and grow heavier. Older adults with diabetes are at risk of developing a similar spectrum of macrovascular and microvascular complications as their younger counterparts with diabetes. In addition, they are at high risk for polypharmacy, functional disabilities, and common geriatric syndromes that include cognitive impairment, depression, urinary incontinence, falls, and persistent pain [1]. This topic will review diabetes management in older patients and how management priorities and treatment choices may differ between older and younger patients. The general management of type 2 diabetes is reviewed separately. (See "Overview of medical care in adults with diabetes mellitus" and "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Management of persistent hyperglycemia in type 2 diabetes mellitus".) TREATMENT GOALS — The overall goals of diabetes management in older adults are similar to those in younger adults and include management of both hyperglycemia and risk factors. Older adults with diabetes are a heterogeneous population that includes persons residing independently in communities, in assisted care facilities, or in nursing homes. They can be fit and healthy or frail with many como Continue reading >>

What Is Considered A Normal Blood Sugar For A 53-year-old Male?

What Is Considered A Normal Blood Sugar For A 53-year-old Male?

Normal blood sugar (glucose) is the same irrespective of gender or adult age. Frequently treatment goals are confused with the normal values which define whether one is normal, has Prediabetes, or Diabetes. Also the answer varies between fasting blood sugar or post-prandial (after eating). So with that preamble: Normal fasting blood sugar is 60–99 mg/dL Normal post- prandial blood sugar is < 140 Prediabetes (fasting) 100–125 Prediabetes (postprandial) 140–199 Diabetes (fasting) > 125 (on 2 separate occasions) Diabetes (postprandial) = or > 200 (on 2 separate occasions unless uniquely high or accompanied by classic diabetes symptoms) Also the Hemoglobin A1c (HbA1c) can be used for diagnosis. This represents a measure of the average blood sugar over the last 3 months. Normal is <5.6% Prediabetes 5.6–6.4% Diabetes >6.4% Treatment goal align with these numbers align but are not the same as the normal numbers, and differ between the ADA (American Diabetes Assn), AACE (American Assn of Clinical Endocrinologists) and the European societies. However the goals are relaxed when someone is older, sicker, more impaired or fragile due to the risks of hypoglycemia- especially if treating with sulfonylureas or insulin. The numbers I quote are from the ADA 2017 Guidelines. Continue reading >>

Managing Type 2 Diabetes

Managing Type 2 Diabetes

The "ABCs" and other tests help your health care team manage your diabetes. Your doctor will set goals for each. A stands for A1C The A1C test measures the average amount of sugar that has been in your blood over the past 2 to 3 months. The American Diabetes Association (ADA) recommends an A1C goal of less than 7% for many adults with diabetes. The A1C goal for some people may need to be higher or lower. Ask your doctor what the right A1C goal is for you. B stands for Blood Pressure Blood pressure is the force of blood moving through your blood vessels. Many people with type 2 diabetes have high blood pressure. High blood pressure means that your heart is working harder than it should to pump blood through your body. You should have your blood pressure checked every time you visit your doctor. The ADA recommends a blood pressure of less than 140/90 mmHg for many adults with diabetes. A different blood pressure goal may be right for you. Ask your doctor what blood pressure goal is right for you. C stands for Cholesterol Cholesterol is a fat-like substance in the blood. LDL (low-density lipoprotein) and HDL (high-density lipoprotein) are 2 types of cholesterol in your blood. LDL is "bad" because it narrows or blocks blood vessels. This can increase your risk of having a heart attack or stroke. HDL is often called "good" because it can carry "bad" cholesterol away from the walls of your arteries. Cholesterol levels are checked with a blood test. Most adults with diabetes should have their cholesterol and triglycerides checked when they are first diagnosed with diabetes, and then every 5 years. Your doctor may choose to check these more often. Triglycerides are another type of fat found in the blood. High triglycerides can raise the risk of heart attack and stroke. Triglyce Continue reading >>

€¢ Heart Disease

€¢ Heart Disease

Know Your Diabetes ABCs Diabetes can harm your blood vessels. It can raise your blood pressure and “bad†cholesterol numbers. If you have diabetes, you may have a greater chance of: • Heart attack • Stroke There are steps you can take to help lower the chance of heart disease and stroke. The American Diabetes Association (ADA) calls these steps the ABCs (A1C, blood pressure, and cholesterol).* Work with your healthcare provider to set goals for your ABCs. Make sure you get the tests you need, when you need them. A is for A1C A1C is a blood test that is often done at your provider’s office. A1C does not replace your blood sugar testing at home. An A1C test tells you: • How well you have managed your blood sugar over the last 2-3 months. • Your average blood sugar during that time. B is for Blood Pressure Blood pressure is the force at which blood pushes through your blood vessels. Blood pressure is measured with two numbers, such as “140 over 80â€. • The first number (“140â€) is the pressure in your blood vessels when your heart is pumping. • The second number (“80â€) is the pressure in your blood vessels when your heart is at rest. High blood pressure (hypertension) makes your heart work harder than it should. This makes it more likely that you could have a heart attack or stroke. (continued) Every visit When to get blood pressure checked? AdA blood pressure goAl My goAl My lAst result Below 140/80 mmHg†___________mmHg *For more information, visit healthy-abcs.html. †Some people with diabetes may have a lower blood pressure goal. Every 3 to 6 months When to get An A1c test? AdA A1c goAl My A1c goAl My A1c result Less than 7% or as your provider recommends ___________% dAte dAte Â� Continue reading >>

Thank You For Joining America’s Diabetes Challenge

Thank You For Joining America’s Diabetes Challenge

America’s Diabetes Challenge: Get to Your Goals is a program from Merck and the American Diabetes Association to urge people with type 2 diabetes to work with their doctor to set and reach their A1C goal (A1C is the average blood glucose over the past 2-3 months). The program also encourages people to learn if they are at risk of low blood glucose, known as hypoglycemia and how to help reduce that risk. Continue reading >>

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