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Diabetes Care Guidelines

Type 2 Diabetes Mellitustreatment & Management

Type 2 Diabetes Mellitustreatment & Management

Type 2 Diabetes MellitusTreatment & Management Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more... The goals in caring for patients with diabetes mellitus are to eliminate symptoms and to prevent, or at least slow, the development of complications. Microvascular (ie, eye and kidney disease) risk reduction is accomplished through control of glycemia and blood pressure; macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction, through control of lipids and hypertension, smoking cessation, and aspirin therapy; and metabolic and neurologic risk reduction, through control of glycemia. New abridged recommendations for primary care providers The American Diabetes Association has released condensed recommendations for Standards of Medical Care in Diabetes: Abridged for Primary Care Providers , highlighting recommendations most relevant to primary care. The abridged version focusses particularly on the following aspects: Diagnosis and treatment of vascular complications Intensification of insulin therapy in type 2 diabetes The recommendations can be accessed at American Diabetes Association DiabetesPro Professional Resources Online, Clinical Practice Recommendations 2015 . [ 121 ] Type 2 diabetes care is best provided by a multidisciplinary team of health professionals with expertise in diabetes, working in collaboration with the patient and family. [ 2 ] Management includes the following: Appropriate self-monitoring of blood glucose (SMBG) Ideally, blood glucose should be maintained at near-normal levels (preprandial levels of 90-130 mg/dL and hemoglobin A1C [HbA1c] levels < 7%). However, focus on glucose alone does not provide adequate treatment for patients with diabetes mellitus. Treatment involves multiple goals (ie, Continue reading >>

Wisconsin Diabetes Mellitus Essential Care Guidelines

Wisconsin Diabetes Mellitus Essential Care Guidelines

Diabetes Care Guidelines The Wisconsin Diabetes Advisory Group recommends use of the American Diabetes Association (ADA) Clinical Practice Recommendations (link is external) for guidance on high-quality, evidence-based diabetes clinical care. The ADA also offers an abridged version for primary care providers, Standards of Medical Care in Diabetes: Abridged for Primary Care Providers (link is external). ADA Clinical Practice Recommendations are based on a complete review of the relevant literature by a diverse group of highly trained clinicians and researchers. After weighing the quality of evidence, from rigorous double-blind clinical trials to expert opinion, recommendations are drafted, reviewed, and submitted for approval to the ADA Executive Committee; they are then revised on a regular basis, and published annually in Diabetes Care. Wisconsin Provider Supplements for Diabetes Care Patient Education Materials Diabetes Self-Care Booklet: This 12-page booklet explains diabetes, diabetes self-care, and lists the tests, exams, and medical checks you need to have in order to take care of your diabetes. Personal Diabetes Care Record: This two-page wallet card provides a place for the person with diabetes to record tests, exams, and medical checks necessary for good self-management. Blood Sugar Log Booklet: This booklet provides a place to record three months of blood sugar test results. All Diabetes Prevention and Control Program resources are copyright-free. Please duplicate and distribute as many copies of these materials as needed. Continue reading >>

What To Know About The Ada's 2018 Standards Of Medical Care If You Have Diabetes

What To Know About The Ada's 2018 Standards Of Medical Care If You Have Diabetes

Living with poorly controlled blood sugar levels may lead to potentially serious health complications for people with diabetes — including diabetic neuropathy, diabetic retinopathy, amputations, depression, sexual issues, heart disease, stroke, and even death. But luckily, if you have type 1 or type 2 diabetes, managing your diet, lifestyle, and treatment well can help you stabilize blood sugar and ultimately reduce the risk of these potential future health issues. To do this, it’s crucial to stay up to date on current treatment standards in the United States — and that starts with turning to the American Diabetes Association (ADA), which releases its Standards of Medical Care each year. What Are the ADA Standards of Care and Why Should You Care? In the ADA’s latest guidelines, released online in December 2017, the organization lists updates in areas related to heart disease and diabetes, new health technology, and more. The standards reflect the latest evidence available to help improve care and health outcomes in people with diabetes, says William T. Cefalu, MD, the chief scientific, medical, and mission officer at the ADA who is based in New Orleans, Louisiana. “The new evidence that has been available this year from published work has been incredible,” Dr. Cefalu says. Although the Standards of Medical Care are primarily geared toward the healthcare community, your diabetes management can benefit if you know about them, says Robert A. Gabbay, MD, PhD, the chief medical officer of the Joslin Diabetes Center in Boston. Following is everything you need to know about the new guidelines if you or a family member has type 1 diabetes, type 2 diabetes, or gestational diabetes. What the 2018 ADA Standards of Medical Care Say Here are some of the major changes and Continue reading >>

Acp Guidance Statement On Hba | Annals Of Internal Medicine | American College Of Physicians

Acp Guidance Statement On Hba | Annals Of Internal Medicine | American College Of Physicians

Author, Article, and Disclosure Information This article was published at Annals.org on 6 March 2018. * This paper, authored by Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Devan Kansagara, MD, MCR; Carrie Horwitch, MD, MPH; Michael J. Barry, MD; and Mary Ann Forciea, MD, was developed for the Clinical Guidelines Committee of the American College of Physicians. Individuals who served on the Clinical Guidelines Committee from initiation of the project until its approval were Mary Ann Forciea, MD (Chair); Nick Fitterman, MD; Kate Balzer, MSW; Michael J. Barry, MD; Cynthia Boyd, MD, MPH; Carrie Horwitch, MD, MPH; Linda L. Humphrey, MD, MPH; Alfonso Iorio, MD, PhD; Devan Kansagara, MD, MCR; Jennifer Lin, MD, MCR; Scott Manaker, MD, PhD; Michael Maroto, JD, MBA; Robert McLean, MD; Reem Mustafa, MD, PhD, MPH; Janice Tufte; Sandeep Vijan, MD, MS; and Timothy J. Wilt, MD, MPH. Approved by the ACP Board of Regents on 26 March 2017. Author (participated in discussion and voting). Nonauthor contributor (participated in discussion but excluded from voting). American College of Physicians, Philadelphia, Pennsylvania (A.Q.) Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.) Oregon Health & Science University and Veterans Affairs Medical Center, Portland, Oregon (D.K.) Virginia Mason Medical Center, Seattle, Washington (C.H.) Massachusetts General Hospital, Boston, Massachusetts (M.J.B.) University of Pennsylvania Health System, Philadelphia, Pennsylvania (M.A.F.) Note: Guidance statements are guides only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP guidance statements are considered automatically withdrawn or invalid 5 years after publication, or once an update h Continue reading >>

Ada Releases 2018 Diabetes Care Guidelines

Ada Releases 2018 Diabetes Care Guidelines

The American Diabetes Association (ADA) released its 2018 Standards of Medical Care in Diabetes this week, and several of the new recommendations involved older adults with co-morbidities, including those with cardiovascular disease or hypertension as well as diabetes. Among the changes in the guidelines relevant to older adults: Based upon the results of multiple cardiovascular outcome trials (CVOT), there are new treatment recommendations for adults with type 2 diabetes, suggesting a pathway for people with heart disease that, after lifestyle management and metformin, should include a medication validated to improve heart health. A new table outlines the data from recent CVOT studies, and a new figure details our recommendations based on those CVOT studies. A new algorithm illustrating the recommended antihypertensive treatment approach for adults with diabetes and confirmed hypertension (blood pressure ≥140/90 mmHg) has been added. Also new this year is the recommendation that all hypertensive patients with diabetes monitor their blood pressure at home to help identify potential discrepancies between office vs. home blood pressure, and to improve medication-taking behavior. The immunization needs for people with diabetes were clarified and updated to more closely align with recommendations from the Centers for Disease Control and Prevention. A new section describes emerging evidence that specific glucose-lowADA releases 2018 diabetes care guidelinesering medications can delay the onset and progression of kidney disease. In addition, three new recommendations targeting older adults were added to highlight the importance of individualizing pharmacologic therapy to reduce the risk of hypoglycemia, avoid overtreatment and simplify complex regimens while maintaining pe Continue reading >>

Ada Issues 2018 Guidelines For Diabetes Care

Ada Issues 2018 Guidelines For Diabetes Care

The American Diabetes Association (ADA) recently issued their annual Standards of Care in Diabetes for 2018. In the latest update, the ADA makes several key recommendations for diabetes care and management, addressing medications with cardiovascular (CV) benefit and treating patients with high blood pressure. The standards offer comprehensive practice evidence-based recommendations that are based on the most current research findings. Among the updated guidelines are recommendations on the use drugs with potential CV benefit, as well as new recommendations involving 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. 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. 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. Youth Diabetes Screening New recommendations note that testing for prediabetes and type 2 diabetes should be considered in children and adoles Continue reading >>

Patient-centered Guidelines For Geriatric Diabetes Care: Potential Missed Opportunities To Avoid Harm

Patient-centered Guidelines For Geriatric Diabetes Care: Potential Missed Opportunities To Avoid Harm

Patient-Centered Guidelines for Geriatric Diabetes Care: Potential Missed Opportunities to Avoid Harm From the Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis (EMM, SEG, NDS); University of Minnesota School of Public Health, Minneapolis (RLK); and the Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis (KDC). Corresponding author: Ellen M. McCreedy, PhD, Center for Gerontology and Healthcare Research, Brown University, School of Public Health, 121 South Main Street, Suite 6, Providence, RI 02903 (E-mail: ellen_mccreedy{at}brown.edu). Background: Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explores how patient characteristics associated with an high risk-to-benefit ratio with hypoglycemia medications affect decision making by primary care clinicians. Methods: Using a vignette-based survey, we queried primary care clinicians on their intended management of geriatric patients with diabetes. The patients' ages, disease durations, and comorbidities were systematically varied. Clinicians indicated whether they would intensify glycemic control by adding a second-line hypoglycemia medication. Results: A convenience sample of 336 primary care clinicians completed the survey. Despite the recommendations for HbA1c targets <8% for more complex patients, an 80-year-old woman with an HbA1c of 7.5%, longstanding diabetes, coronary disease, and cognitive impairment and with instrumental activity of daily living dependencies, had a predicted probability of treatment intensification of 35%. Internists were 11% and nurse practitioners were 14% more likely to intensify treatment than family physicians ( Continue reading >>

What's New In The 2013 Guidelines For Diabetes Care?

What's New In The 2013 Guidelines For Diabetes Care?

What's new in the 2013 guidelines for diabetes care? New recommendations from the 2013 guidelines for diabetes care Martha Funnell is an associate research scientist in the Department of Medical Education at the University of Michigan Medical School in Ann Arbor, Mich. Supported in part by Grant Number P30DK092926 (MCDTR) from the National Institute of Diabetes and Digestive and Kidney Diseases. The author has disclosed that she has no financial relationships related to this article. 2013 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Thought you might appreciate this item(s) I saw at Nursing2018. Your message has been successfully sent to your friend. Some error has occurred while processing your request. Please try after some time. Thought you might appreciate this item(s) I saw at Nursing2018. Your message has been successfully sent to your friend. Some error has occurred while processing your request. Please try after some time. The item(s) has been successfully added to "". Thought you might appreciate this item(s) I saw at Nursing2018. Your message has been successfully sent to your friend. Some error has occurred while processing your request. Please try after some time. Data is temporarily unavailable. Please try again soon. Copyright2018 Wolters Kluwer Health, Inc. All rights reserved. This Wolters Kluwer website uses cookies and similar techniques, to improve the functionality and performance of this website and the services of Wolters Kluwer, to understand how you use the eJournal services, and to provide you with customized ads and other recommendations. Third parties may also place cookies on this website for of advertising, tracking and analytics purposes. These cookies allow us and third parties to track your internet behavior on and possibly Continue reading >>

Updated Type 1 Diabetes Treatment Guidelines

Updated Type 1 Diabetes Treatment Guidelines

This article requires a subscription for full access. NEJM Journal Watch articles published within the last six months are available to subscribers only. Articles published more than 6 months ago are available to registered users. Continue reading >>

My Site - Chapter 6: Organization Of Diabetes Care

My Site - Chapter 6: Organization Of Diabetes Care

Organized around the person living with diabetes and their supports. The person with diabetes should be an active participant in their own care, be involved in shared-care decision making and self-manage to their full abilities. Facilitated by a proactive, interprofessional team with training in diabetes and the ability to provide ongoing self-management education and support. Organized within the context of the expanded chronic care model and delivered using as many of the components of the model as possible (in particular, self-management education and support; interprofessional team-based care with expansion of professional roles; collaboration with the primary care provider and monitoring with medication adjustment and case management). Structured, evidence based and supported by clinical information and decision support systems that include patient registries, clinician and patient reminders, facilitated relay of information, audits, feedback and benchmarking. Any of the above strategies may be facilitated with telehealth technologies. Key Messages for People Living with Diabetes Know the members of your diabetes team and stay connected with them. Remember you are the most important member of the team. Be prepared to learn how to care for your diabetes on a daily basis. Also, be ready to share in decision making regarding how you will care for your diabetes and health. Prepare for visits with your diabetes health-care team: Have laboratory tests done prior to the visit so the results will be available to review at the visit. Be prepared to set and update your personal goals for caring for your diabetes and health. Be prepared to share any issues that may affect your ability to care for your diabetes on a daily basis, including any fears or anxiety you may have. Br Continue reading >>

Mental Health Support Lacking In U.s. Diabetes Care

Mental Health Support Lacking In U.s. Diabetes Care

Mental health support lacking in U.S. diabetes care (Reuters Health) - Most of the top diabetes treatment centers in the U.S. provide experts in hormonal disease, diet and nutrition and diabetes education as part of normal care, but mental health support is still not standard, researchers say. In a survey of 37 top institutions, most of them treating thousands of diabetes patients per year, barely 4 in 10 said they had a behavioral health professional integrated into the practice, and even these were typically just part-time. In contrast, 100 percent had full-time hormone specialists known as endocrinologists, 98 percent had diabetes educators and 92 percent had registered dieticians and nurse practitioners, the study team reports in a research letter to the journal Diabetes Care. Past research suggests that psychosocial interventions . . . improve diabetes outcomes and that behavioral interventions aimed at changing self-management behaviors have been associated with improvements in quality of life, lead author Samantha Barry, Diabetes Center of Excellence at the University of Massachusetts Medical Center in Worcester said in an email. In late 2016, the American Diabetes Association (ADA) put out guidelines urging that psychosocial care should be a standard part of diabetes care, and encouraging medical providers to identify and coordinate with qualified behavioral and mental health care professionals, Barry and her colleagues note. The recommendation was reiterated in the latest ADA standard of care guidelines. To see whether mental health support is becoming more common, Barrys team identified diabetes practices that were members of the ADA or American Diabetes Educators Association and sent a survey to each clinics leadership. Seventy percent of the centers attende Continue reading >>

Guidelines For Geriatric Diabetes Care

Guidelines For Geriatric Diabetes Care

J Am Board Fam Med; 2018 Mar-Apr; McCreedy, et al In geriatric diabetes care, primary care clinicians often chose to intensify glycemic control despite individual factors that may warrant higher glycemic targets based on existing ADA guidelines. Using a vignette-based survey, 336 primary care clinicians were queried on their intended management of geriatric patients with diabetes and whether they would intensity glycemic control by adding a second-line hypoglycemia medication. Researchers found: Despite recommendations for HbA1c targets <8% for more complex patients, a woman aged 80 with an HbA1c of 7.5%, longstanding diabetes, coronary disease, and cognitive impairment and with instrumental activity of daily living dependencies, had a predicted probability of treatment intensification of 35%. Internists were 11% and nurse practitioners were 15% more likely to intensify treatment than family physicians. Providers in Florida were more likely to intensify treatment. McCreedy EM, Kane RL, Gollust SE, Shippee ND, Clark KD. Patient-centered guidelines for geriatric diabetes care: Potential missed opportunities to avoid harm. J Am Board Fam Med. 2018;31(2):192-200. doi:10.3122/jabfm.2018.02.170141. Continue reading >>

New Treatment Guidelines For Diabetes

New Treatment Guidelines For Diabetes

Authors: News Author: Miriam E Tucker; CME Author: Charles P. Vega, MD, FAAFP Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s) Family Physicians - maximum of 0.25 AAFP Prescribed credit(s) ABIM Diplomates - maximum of 0.25 ABIM MOC points Nurses - 0.25 ANCC Contact Hour(s) (0.25 contact hours are in the area of pharmacology) Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs) This article is intended for primary care physicians, endocrinologists, obstetrician-gynecologists, nurses, pharmacists, and other clinicians who care for individuals with diabetes. The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care. Upon completion of this activity, participants will be able to: Distinguish appropriate glycemic targets for patients with diabetes Assess best practices in the pharmacologic treatment of diabetes As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Disclosure: Miriam E. Tucker has disclosed no relevant financial relationships. Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships. Health Sciences Clinical Professor, Univer Continue reading >>

Implementing Diabetes Care Guidelines In Long Term Care - Sciencedirect

Implementing Diabetes Care Guidelines In Long Term Care - Sciencedirect

Volume 14, Issue 11 , November 2013, Pages 851.e7-851.e15 The objectives of this article are to (1) describe the outcomes of a diabetes care program in a long term care facility dedicated to diabetes excellence and (2) compare the relevant outcome variables of research published between 2007 and 2012 with the results found in the studied facility. Three-year retrospective chart review of the facility's residents with comparison to extant literature. A total of 224 resident charts within the studied facility were reviewed. Residents with a diagnosis of diabetes, or who were on diabetes medications, or whose fasting blood sugars exceeded 126 mg/dL on 2 occasions, and whose length of stay exceeded 6 months, were tracked for adherence to diabetes guidelines (n= 48). Participant outcomes from relevant studies in the literature were compared to these 48 participants' outcomes. All levels of staff in the studied facility were educated in general diabetes care. A nurse practitioner was contracted to provide medical care for all diabetic residents (with primary care provider approval). A scorecard for adherence to diabetes guidelines was completed by the nurse practitioner. Over a 3-year period following the education program and scorecard implementation, a chart review of all residents was completed by a consulting diabetes educator/nurse practitioner/nurse faculty member and 6 undergraduate nursing students. In general, the nursing home in the present study compared favorably with other relevant studies, demonstrating lower A1C levels, tracking blood sugars more regularly, monitoring blood pressure and lipids more regularly, having a greater percentage of patients on lipid-lowering medications among those in need, more appropriate use of sliding scale insulin, greater adheren 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 >>

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