Standards Of Medical Care In Diabetes—2016
General Changes In alignment with the American Diabetes Association’s (ADA’s) position that diabetes does not define people, the word “diabetic” will no longer be used when referring to individuals with diabetes in the “Standards of Medical Care in Diabetes.” The ADA will continue to use the term “diabetic” as an adjective for complications related to diabetes (e.g., diabetic retinopathy). Although levels of evidence for several recommendations have been updated, these changes are not included below as the clinical recommendations have remained the same. Changes in evidence level from, for example, C to E are not noted below. The “Standards of Medical Care in Diabetes—2016” contains, in addition to many minor changes that clarify recommendations or reflect new evidence, the following more substantive revisions. Section Changes Section 1. Strategies for Improving Care This section was revised to include recommendations on tailoring treatment to vulnerable populations with diabetes, including recommendations for those with food insecurity, cognitive dysfunction and/or mental illness, and HIV, and a discussion on disparities related to ethnicity, culture, sex, socioeconomic differences, and disparities. Section 2. Classification and Diagnosis of Diabetes The order and discussion of diagnostic tests (fasting plasma glucose, 2-h plasma glucose after a 75-g oral glucose tolerance test, and A1C criteria) were revised to make it clear that no one test is preferred over another for diagnosis. To clarify the relationship between age, BMI, and risk for type 2 diabetes and prediabetes, the ADA revised the screening recommendations. The recommendation is now to test all adults beginning at age 45 years, regardless of weight. Testing is also recommended for asym Continue reading >>
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2010 Aaha Diabetes Management Guidelines For Dogs And Cats
Renee Rucinsky, DVM, ABVP (Feline) (Chair) | Audrey Cook, BVM&:S, MRCVS, Diplomate ACVIM-SAIM, Diplomate ECVIM-CA | Steve Haley, DVM | Richard Nelson, DVM, Diplomate ACVIM | Debra L. Zoran, DVM, PhD, Diplomate ACVIM | Melanie Poundstone, DVM, ABVP - Download PDF - Introduction Diabetes mellitus (DM) is a treatable condition that requires a committed effort by veterinarian and client. This document provides current recommendations for the treatment of diabetes in dogs and cats. Treatment of DM is a combination of art and science, due in part to the many factors that affect the diabetic state and the animal's response. Each animal needs individualized, frequent reassessment, and treatment may be modified based on response. In both dogs and cats, DM is caused by loss or dysfunction of pancreatic beta cells. In the dog, beta cell loss tends to be rapid and progressive, and it is usually due to immune-mediated destruction, vacuolar degeneration, or pancreatitis.1 Intact females may be transiently diabetic due to the insulin-resistant effects of the diestrus phase. In the cat, loss or dysfunction of beta cells is the result of insulin resistance, islet amyloidosis, or chronic lymphoplasmacytic pancreatitis.2 Risk factors for both dogs and cats include insulin resistance caused by obesity, other diseases (e.g., acromegaly in cats, hyperadrenocorticism in dogs), or medications (e.g., steroids, progestins). Genetics is a suspected risk factor, and certain breeds of dogs (Australian terriers, beagles, Samoyeds, keeshonden3) and cats (Burmese4) are more susceptible. Regardless of the underlying etiology, diabetic dogs and cats are hyperglycemic and glycosuric, which leads to the classic clinical signs of polyuria, polydipsia (PU/PD), polyphagia, and weight loss. Increased fat mobi Continue reading >>
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Diabetes Mellitus Treatment
In patients diagnosed with diabetes mellitus (DM), the therapeutic focus is on preventing complications caused by hyperglycemia. In the United States, 57.9% of patients with diabetes have one or more diabetes-related complications and 14.3% have three or more.[1] Strict control of glycemia within the established recommended values is the primary method for reducing the development and progression of many complications associated with microvascular effects of diabetes (eg, retinopathy, nephropathy, and neuropathy), while aggressive treatment of dyslipidemia and hypertension further decreases the cardiovascular complications associated macrovascular effects.[2-4] See the chapter on diabetes: Macro- and microvascular effects. Glycemic Control Two primary techniques are available to assess a patient's glycemic control: Self-monitoring of blood glucose (SMBG) and interval measurement of hemoglobin A1c (HbA1c). Self-Monitoring of Blood Glucose Use of SMBG is an effective method to evaluate short-term glycemic control. It helps patients and physicians assess the effects of food, medications, stress, and activity on blood glucose levels. For patients with type 1 DM or insulin-dependent type 2 DM, clinical trials have demonstrated that SMBG plays a role in effective glycemic control because it helps to refine and adjust insulin doses by monitoring for and preventing asymptomatic hypoglycemia as well as preprandial and postprandial hyperglycemia.[2,5-7] The frequency of SMBG depends on the type of medical therapy, risk for hypoglycemia, and need for short-term adjustment of therapy. The current American Diabetes Association (ADA) guidelines recommend that patients with diabetes self-monitor their glucose at least three times per day.[8] Those who use basal-bolus regimens should s Continue reading >>
Overview Of Medical Care In Adults With Diabetes Mellitus
INTRODUCTION The estimated overall prevalence of diabetes among adults in the United States ranges from 5.8 to 12.9 percent (median 8.4 percent) [1,2]. More personal health care resources are estimated to be spent on diabetes than any other condition [3]. Numerous factors, in addition to directly related medical complications, contribute to the impact of diabetes on quality of life and economics. Diabetes is associated with a high prevalence of depression [4] and adversely impacts employment, absenteeism, and work productivity [5]. This review will provide an overview of the medical care for patients with diabetes (table 1). The management approach is consistent with guidelines from the American Diabetes Association (ADA) for health maintenance in patients with diabetes, which are published yearly [6]. Consensus recommendations for the management of glycemia in type 2 diabetes were published in 2006 and are updated regularly. Detailed discussions relating to screening, diagnosis, and management of hyperglycemia are discussed separately. (See "Screening for type 2 diabetes mellitus" and "Clinical presentation and diagnosis of diabetes mellitus in adults" and "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Management of persistent hyperglycemia in type 2 diabetes mellitus".) EVALUATION Initial — Patients with newly diagnosed diabetes require a history and physical examination to assess the characteristics of onset of diabetes (asymptomatic laboratory finding or symptomatic polyuria and polydipsia), nutrition and weight history, physical activity, cardiovascular risk factors, history of diabetes-related complications, hypoglycemic episodes, diabetic ketoacidosis (DKA) frequency (type 1 diabetes only), and current management. Although th Continue reading >>
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Updates To American Diabetes Association’s Standards Of Care For 2016
Every year, the American Diabetes Association (ADA) publishes their updated guidelines for the standards of medical care in diabetes. For 2016, the biggest changes was to management of obesity in treating Type 2 diabetes, changes with treatment of heart disease, and differences in care for certain populations of patients. The new guidelines also address updated goals for treatment, and new tools for evaluating the quality of care. They recommend adjusting treatment to improve the care of vulnerable populations. This gives clinicians a guide for treating differences and disparities in the areas of culture, ethnicity, socioeconomic, and gender. Guidelines include strategies for helping diabetes patients who struggle with cognitive problems, mental illness, food insecurity, and HIV. The new guidelines were published online on December 22, 2015, in advance of the print publication in a supplement to the January edition of Diabetes Care. The updates call for a tiered approach to the management of obesity. They look at lifestyle intervention, use of medications to treat obesity, and weight loss (bariatric) surgery. There is a new section on the medical and surgical management of people who have diabetes. It addresses previous bariatric surgery recommendations and provides guidance for a thorough assessment of weight in diabetes. It looks at using behavior change and medications to address overweight and obesity, and includes a new table of medications that are approved for the long-term treatment of obesity. Weight loss medications should be discontinued if less than 5% weight loss is achieved after three months of use. A 5% weight loss is targeted, by achieving a deficit of 500-750 calories per day. High intensity counseling interventions should number at least 16 sessions o Continue reading >>
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Metformin For Prediabetes
This Issue The oral biguanide metformin (Glucophage, and others) is generally the drug of choice for initial treatment of type 2 diabetes. It has also been used to prevent or at least delay the onset of diabetes in patients considered to be at high risk for the disease. Recent guidelines recommend considering use of metformin in patients with prediabetes (fasting plasma glucose 100-125 mg/dL, 2-hr post-load glucose 140-199 mg/dL, or A1C 5.7-6.4%), especially in those who are <60 years old, have a BMI >35 kg/m2, or have a history of gestational diabetes.1 Metformin has not been approved for such use by the FDA. Continue reading >>
Clinical Guidelines In Endocrinology
CLINICAL GUIDELINES IN ENDOCRINOLOGY Dace Trence, MD, FACE Division of Metabolism, Endocrinology, and Nutrition, Director, Endocrine Fellowship Program, Director, Diabetes Care Center, University of Washington Medical Center Topics are listed in Categories in the following arbitrary order-- Diabetes, Adrenal, Thyroid, Pituitary, Male Endocrinology, Female Endocrinology, Obesity, Bones Disease, Metabolic Problems, Pediatric Endocrine Problems Limited to guidelines dated/updated within past 5 years, preferably with evidence based grading, published in peer reviewed literature, and those that are not revisions of other organization guidelines Category: Diabetes and hyperglycemia Standards of MedicCare in Diabetes—2014 Last updated: 2014 Published: Diabetes Care January 2014; 37:S14-S80 Sponsor: American Diabetes Association Website: Management of Type 2 Diabetes Mellitus in Children and Adolescents Published: Pediatrics 2013;13:364–382, technical summary, Pediatrics 2013;131:e648–e664 Sponsor: American Academy of Pediatrics Website: Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting Last Updated: 2012 Published: J Clin Endocrinol Metab, 2012, 97:16–38. Sponsor: Endocrine Society Website: Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline From the American College of Physicians Last Updated: 2012 Published: Ann Intern Med. 2012; 156:218-231 Sponsor: American College of PhysiciansWebsite: Diagnosis and management of type 2 diabetes mellitus in adults Last updated: 2012 Published: Web-based document Sponsor: Institute for Clinical Systems Improvement Website: Adult Diabetes Clinical Practice Guidelines Last updated: 2012 Published: Online Sponsor: Kaiser Permanente Care Management Institute Website: C Continue reading >>
Pakistan Endocrine Society Guidelines For Treatment Of Type 2 Diabetes Mellitus.
Pakistan Endocrine society is in the process of developing Guidelines for type 2 Diabetes Mellitus.In this process 8 consultative meetings under the chairman ship of Prof A.H.Aamir were held at 1.Lahore (2 meetings) 2. Multan 3. Islamabad. 4.Peshawar 5.Quetta 6.Karachi.(2 meetings) All the Executives were part of this consultative meetings apart from Professors, internist, General Physicians from across the country.Initial draft and issues were shared through email and later at meetings in major cities of the country. Continue reading >>
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Jardiance Gets A Boost As Ada Treatment Guidelines 2017
American Diabetes Association Guidelines 2017 The American Diabetes Association has recommended the med in its official guidelines for 2017. The ADA gave the product a shoutout in its 2017 Standards of Medical Care in Diabetes, backing it to reduce the risk of cardiovascular death in Type 2 patients with established cardiovascular disease. That recommendation comes on the back of an outcomes trial that last year showed Jardiance could pare down CV death risk by 38%. As Barclays analyst Geoff Meacham wrote in a note to clients, the recommendation “received a B-level assessment in terms of strength of the evidence, which may reflect the ADA’s views on the various cardiovascular endpoint components” in the companies’ outcomes trial. Nevertheless, though, he views the recommendation “as a positive” for the companies Meanwhile, Jardiance’s market share is already on the rise within the SGLT2 class, he pointed out. For the week ended Dec. 9, it logged new prescription share of 22.1% and total prescription share of 21.1%. The ADA recommendation might give the product another boost; it warned that whether “other SGLT2 inhibitors will have the same effect in high-risk patients ... remains unknown.” That wording may negate some of the “class effect” Jardiance’s rivals have been enjoying since its outcomes data hit late last year. While Johnson & Johnson, which makes Invokana, and AstraZeneca, the manufacturer of Farxiga, won’t wrap up their respective outcomes trials until 2017 and 2019, respectively, they’ve managed to piggyback on some of Jardiance’s success under the assumption that they’ll turn up similar results. www red DiabetologNytt Continue reading >>
Ispad Clinical Practice Consensus Guidelines 2014
Editor in Chief: Mark A. Sperling, Pittsburgh, USA. Guest Editors: Carlo Acerini, Maria E Craig, Carine de Beaufort, David M Maahs and Ragnar Hanas. Introduction Carlo Acerini, Maria E Craig, Carine de Beaufort, David M Maahs and Ragnar Hanas. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 1–3. Uploaded: 2. Sept 2014 Download Introduction Chapter 1: Definition, epidemiology, diagnosis and classification Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 4–17. Uploaded: 2. Sept 2014 Download Chapter 1 Chapter 2: Phases of Type 1 Diabetes Couper JJ, Haller MJ, Ziegler A-G, KnipM, Ludvigsson J, Craig ME. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 18–25. Download Chapter 2 Chapter 3: Type 2 diabetes Zeitler P, Fu J, Tandon N, Nadeau K, Urakami T, Bartlett T, Maahs D. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 26-46. Uploaded: 2. Sept 2014 Download Chapter 3 Chapter 4: The Diagnosis and Management of Monogenic diabetes Rubio-Cabezas O, Hattersley AT, Njølstad PR, Mlynarski W, Ellard S,White N, Chi DV, Craig ME. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 47-64. Uploaded: 2. Sept 2014 Download Chapter 4 Chapter 5: Management of cystic fibrosis-related diabetes Moran A, Pillay K, Becker DJ, Acerini CL. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 65-76. Uploaded: 2. Sept 2014 Download Chapter 5 Chapter 6: Diabetes education Lange K, Swift P, Pankowska E, Danne T. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 77-85. Uploaded: 2. Sept 2014 Download Chapter 6 Chapter 7: The delivery of ambulatory diabetes care Pihoker C, Forsander G, Fantahun B, Virmani A, Luo X, Hallman M, Wolfsdorf J, Maahs DM. Published in Pediatric Diabetes 2014: 15(Suppl. 20): 86-101. Up Continue reading >>
(video) New Guidelines For Type-2 Diabetes Treatment To Include Surgery
NOTE: Members of the media may download multimedia assets for editorial use here. Bariatric surgery has been known to enhance weight loss for people struggling with obesity and now the American Diabetes Association (ADA) is including bariatric surgery as a recommended treatment option for people who suffer from Type 2 diabetes. More treatment options Philip Schauer, M.D., of Cleveland Clinic said these new guidelines are important because they give doctors another tool when treating those with Type 2 diabetes who are not responding well to traditional medical therapy. “Type two diabetes is rampant in this country, it is a major killer,” said Dr. Schauer. “It’s the seventh biggest killer in our country; it is the major cause of blindness, of kidney failure and amputations in our country and despite the fact there has been better drug treatment, still many patients are not in good control.” Dr. Schauer said the goal with these new guidelines is to be able to put more people in control of their diabetes and more people into remission. Research behind the recommendation Previously, people struggling with Type 2 diabetes were typically put on diet and exercise plans, and sometimes medication, to help lower their blood sugar levels. While bariatric surgery was an option, it was often considered to be a specialized service. The new recommendations take into consideration data collected worldwide from more than 11 clinical trials conducted over the past 10 years. Among them was a trial conducted by Cleveland Clinic, which showed that those with Type 2 diabetes who had bariatric surgery were better able to meet their target blood sugar level goals than those who received traditional medical therapy. Available to more people With these new guidelines, bariatric surgery Continue reading >>
Diabetes Mellitus
Facts on glycaemic control in a nutshell Discover general recommendations on the management of diabetes mellitus. ESC and European Association for the Study of Diabetes scientific statements (Ryden L 2013) as well as the most recent ESC Prevention Guideline (Piepoli MF 2016) call on page 2355 for lifestyle management as a first line intervention for the prevention and treatment of diabetes mellitus type 2 (DMT2). In brief: hyperglycaemia is a symptom of multiple causes, and therefore requires a multifactorial approach and thus comprehensive lifestyle changes, especially in DMT2 physical activity is key to increasing caloric expenditure, combatting insulin resistance, reducing hospitalizations and improving the prognosis physical activity supported by sustainable dietary changes improves weight control and, more importantly, induce weight loss strict glycaemic control reduces the risk of microvascular and macrovascular complications; so does a systolic blood pressure ≤140 mmHg, whereas ≤ 130 mmHg even further lessens the risks for stroke, retinopathy and albuminuria and should therefore be the target if tolerated if tight glycaemic and/or blood pressure control are/is not tolerated, temporarily consider relaxed targets in the elderly, frail and / or those with long-term DM and /or cardiovascular disease; however, reconsider stricter targets after timely reassessment statins are recommended in all DMT2 patients >40 years and selected younger patients at high risk in DMT2 with co-existing cardiovascular disease, a sodium-glucose co-transporter-2 (SGLT2) inhibitor should be considered early since it improves prognosis without major adverse effects improved risk factor management reduces cardiovascular mortality in DMT2 – more needs to be done to reach all patients in Continue reading >>
Diagnosis And Management Of Diabetes: Synopsis Of The 2016 American Diabetes Association Standards Of Medical Care In Diabetes Free
Description: The American Diabetes Association (ADA) published the 2016 Standards of Medical Care in Diabetes (Standards) to provide clinicians, patients, researchers, payers, and other interested parties with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Methods: The ADA Professional Practice Committee performed a systematic search on MEDLINE to revise or clarify recommendations based on new evidence. The committee assigns the recommendations a rating of A, B, or C, depending on the quality of evidence. The E rating for expert opinion is assigned to recommendations based on expert consensus or clinical experience. The Standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community was incorporated into the 2016 revision. Recommendations: The synopsis focuses on 8 key areas that are important to primary care providers. The recommendations highlight individualized care to manage the disease, prevent or delay complications, and improve outcomes. Since 1989, the American Diabetes Association (ADA) Standards of Medical Care in Diabetes (Standards) have provided the framework for evidence-based recommendations to treat patients with diabetes. This synopsis of the 2016 ADA Standards highlights 8 areas that are important to primary care providers: diagnosis, glycemic targets, medical management, hypoglycemia, cardiovascular risk factor management, microvascular disease screening and management, and inpatient diabetes management. The ADA Professional Practice Committee (PPC), which comprises physicians, diabetes educators, registered dietitians, and public health experts, developed Continue reading >>
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Diabetes Guidelines Of 2016: Update On Updates
Important updates of the past year sought to recognize the importance of obesity care and the need to better integrate behavioral health into diabetes care. Guidelines that affect diabetes care come from many places: professional societies, advocacy groups, and regulators weigh in on when to use certain drugs and what standards should apply for medical devices. Whether they represent updates to existing standards or cover new ground, guidelines not only affect clinical decisions, but they also drive coverage decisions by payers—and thus, access for patients. The relationship between obesity and diabetes, and the recognition that unmet behavioral health needs affect outcomes drove updates in 2016. Below are some key changes that will affect both diabetes care and payer decisions going into the new year: AACE/ACE issue joint update on type 2 diabetes algorithm. The year began with an update from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) on care of patients with type 2 diabetes (T2D). The statement emphasized the need to improve lifestyle management first, to individualize both targets for glycated hemoglobin (A1C) and therapy regimens, based on factors that included cost and likelihood of adherence. Evaluating “cost” must go beyond the price of medication and factor in monitoring, hypoglycemia risk, and likelihood of weight gain. Endocrinology groups weigh in on SGLT2 inhibitors: On April 15, 2016, AACE and ACE published a joint statement on diabetic ketoacidosis (DKA); the statement said the condition does not occur more frequently among patients with T2D taking sodium glucose co-transporter-2 (SGLT2) inhibitors than it does generally. This statement was based on a meeting of leaders in the field th Continue reading >>
