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Standards Of Medical Care In Diabetes 2018

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 >>

2018 Ada Standards Of Medical Care In Diabetes

2018 Ada Standards Of Medical Care In Diabetes

2018 ADA Standards of Medical Care in Diabetes Dec 20, 2017 | posted by Kelsey Bennett | Patient Care | No comments The American Diabetes Association published its Standards of Care for Diabeteslast week with the help of a committee led by Rita Kalyani , associateprofessor in the Division of Endocrinology.She has served as chair of the writing committeefor thepast year to update the 173-page clinical guidelinesthat summarize evidence-based recommendations for the management and treatment of the 30 million people living with diabetes in the U.S.Major changesincluderevising the fundamental algorithm for sequencing antihyperglycemic therapies in people with type 2 diabetes to incorporate results from recent CV outcomes trials. For a full copy of the guidelines, visit: For more information about the changes, visit: For the Medscape article regarding the changes, visit: Continue reading >>

2018 Standards Of Medical Care In Diabetes

2018 Standards Of Medical Care In Diabetes

2018 Standards of Medical Care in Diabetes Home // ... // Clinical Laboratory News // CLN Stat // 2018 Standards of Medical Care in Diabetes 2018 Standards of Medical Care in Diabetes In annual update ADA revises glycemic targets, screening protocols, expands recommendations for continuous glucose monitoring in adults. The American Diabetes Association (ADA) in its 2018 Standards of Medical Care in Diabetes is recommending continuous glucose monitoring (CGM) to all adults 18 and over who arent meeting glycemic targets, as well as screening high-risk youths for type 2 diabetes. The revised guidelines, published in Diabetes Care, also created new specifications for applying the HbA1c (A1C) test. Since 1989, the American Diabetes Association has provided annual updates to theStandards of Care, and the Standards are accepted as the global standard for diabetes care, said ADAs Chief Scientific, Medical and Mission Officer William T. Cefalu, MD, in a statement . ADA plans on updating this document throughout the year in light of new technology, research, and therapy developments, Cefalu said. Two sections in this guidanceclassification and diagnosis of diabetes and glycemic targetsspecifically address the limitations of A1C measurements. A number of different factors can affect the results of this test, including assay interference, hemoglobin variants, and variations in red blood cell turnover rates, as well as age, pregnancy, and ethnicity. ADA clarified how A1C should be used to help diagnose and monitor diabetes, recommending that clinicians use alternatives such as fasting plasma glucose or oral glucose tolerance tests in the event that A1C results and blood glucose levels dont agree. The guidance suggested that A1C testing take place just twice a year in patients who a Continue reading >>

Ada 2018 Standards Address Diabetes Drugs With Cv Benefit

Ada 2018 Standards Address Diabetes Drugs With Cv Benefit

ADA 2018 Standards Address Diabetes Drugs With CV Benefit The American Diabetes Association's annual guidelines for 2018 include new recommendations for use of glucose-lowering drugs with proven cardiovascular benefit in type 2 diabetes, optimization of diabetes care in elderly patients, and glucose screening of high-risk adolescents. The organization has also chosen to stick with its existing definition of hypertension in diabetes, of 140/90 mm Hg, in contrast to cardiology societies that have recently changed their guidance so that 130/80 mm Hg represents "stage 1 hypertension," including in diabetes. Probably the most anticipated and impactful new recommendation from the ADA calls for use of a glucose-lowering agent with proven cardiovascular benefit such as the glucagonlike peptide 1 (GLP-1) agonist liraglutide (Victoza Novo Nordisk) and/or mortality reduction such as that observed with the sodium glucose cotransporter-2 (SGLT2) inhibitor empagliflozin (Jardiance, Boehringer Ingelheim/Lilly) in type 2 diabetes patients with established atherosclerotic cardiovascular disease (ASCVD) who don't meet glycemic targets with lifestyle modification and metformin. "We now have drugs that are not only indicated to improve glycemic control but that reduce cardiovascular risk and mortality. So, based on some of the [ cardiovascular-outcomes] trials , there are new recommendations for treatment of adults with type 2 diabetes who fail metformin therapy, if there's a background of atherosclerotic cardiovascular disease," the ADA's chief scientific, medical, and mission officer, William T Cefalu, MD, told Medscape Medical News. A new table outlines the data from recent cardiovascular-outcomes studies, and a new figure details the recommendations based on those (Section 8, page S97 Continue reading >>

Ada's Standards Of Medical Care In Diabetes - 2018

Ada's Standards Of Medical Care In Diabetes - 2018

Unfortunately, that's where my praise ends. What I was hoping would be different are the following recommendations: (Everything within a quote below is taken directly from the ADA 2018 Standards of Care Series) "An A1C goal of <7.5% (58 mmol/mol) is recommended across all pediatric age-groups." Regarding dyslipidemia (High Cholesterol/triglycerides): "Initial therapy should consist of optimizing glucose control and medical nutrition therapy using a Step 2 American Heart Association diet to decrease the amount of saturated fat in the diet." "The American Heart Association categorizes children with type 1 diabetes in the highest tier for cardiovascular risk and recommends both lifestyle and pharmacologic treatment for those with elevated LDL cholesterol levels." "Initial therapy should be with a Step 2 American Heart Association diet, which restricts saturated fat to 7% of total calories and restricts dietary cholesterol to 200 mg/day. Data from randomized clinical trials in children as young as 7 months of age indicate that this diet is safe and does not interfere with normal growth and development." "After the age of 10 years, addition of a statin is suggested in patients who, despite medical nutrition therapy and lifestyle changes, continue to have LDL cholesterol >160 mg/dL (4.1 mmol/L) or LDL cholesterol >130 mg/dL (3.4 mmol/L) and one or more cardiovascular disease risk factors, following reproductive counseling and implementation of effective birth control due to the potential teratogenic effects of statins." "Neither long-term safety nor cardiovascular outcome efficacy of statin therapy has been established for children; however, studies have shown short-term safety equivalent to that seen in adults and efficacy in lowering LDL cholesterol levels." "The atheroscl 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 >>

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 >>

The 2018 Standards Of Medical Care In Diabetes Are Here!

The 2018 Standards Of Medical Care In Diabetes Are Here!

The 2018 Standards of Medical Care in Diabetes Are Here! Each year, I look forward to the annual release of the Standards of Medical Care in Diabetes published by the American Diabetes Association. Well, the 2018 Standards have arrived! We are so fortunate to have such a body of work that is updated each year and puts the most recent evidence for diabetes care at our fingertips. As in past years, there are comprehensive reviews of all aspects of diabetes management, as well as an abridged version for primary care providers . Consider sharing this with providers with whom you work. There are a couple of sections I jump to that are especially helpful to me. I start with the Summary of Revisions section, which highlights the recent changes. It gives a brief overview of each revision to the Standards. Then, I go to specific sections that have changed if I want more detail. To no surprise, I next go to the section on lifestyle management . This section covers diabetes self-management education and support (DSMES), nutrition therapy, physical activity, smoking cessation, and psychological issues. I am pleased to see the first three references include: Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics Diabetes Self-management Education and Support in Type 2 Diabetes including the four critical times a person with diabetes should be referred to, and receive, DSMES. Each of these documents warrants a separate review. There have been big changes in how, why and when we interact with a person with diabetes. Each of the other sections in the standards provides valuable information for so many other aspects of our work. We have wonderful evidence to help a person with diabetes, i Continue reading >>

Ada Updates Standards Of Medical Care In Diabetes

Ada Updates Standards Of Medical Care In Diabetes

ADA Updates Standards of Medical Care in Diabetes The American Diabetes Association (ADA) has released its Standards of Medical Care in Diabetes2018 guideline. Among the major changes: Classification and diagnosis: The appropriate use of A1c testing is clarified. Prevention or delay of diabetes: The recommendation regarding metformin better reflects Diabetes Prevention Program data. Glycemic targets: CGM should be used in all adults with T1D who are not meeting glycemic targets. Obesity management: NADAC medication prices are included. Pharmacologic approaches to glycemic treatment: People with ASCVD should begin with lifestyle management and metformin, and subsequently incorporate an agent. CVD and risk management: All hypertensive patients with diabetes should monitor their blood pressure at home. Older adults: 3 new recommendations are added to highlight the importance of individualizing pharmacologic therapy in this group. Children and adolescents: Additional recommendations were added on T1D treatment of children/adolescents regarding intensive insulin regimens, glucose self-monitoring, CGM, and automated insulin delivery. Management of diabetes in pregnancy: Insulin is the preferred agent for the management of T1D and T2D in pregnancy. Continue reading >>

Ada Releases 2018 Standards Of Care For Diabetes

Ada Releases 2018 Standards Of Care For Diabetes

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

Review Of The Ada Standards Of Medical Care In Diabetes 2018 | Annals Of Internal Medicine | American College Of Physicians

Review Of The Ada Standards Of Medical Care In Diabetes 2018 | Annals Of Internal Medicine | American College Of Physicians

Author, Article, and Disclosure Information This article was published at Annals.org on 3 April 2018. St. Mark's Hospital and St. Mark's Diabetes Center, Salt Lake City, Utah (J.J.C.) UND School of Medicine and Health Sciences, Grand Forks, North Dakota (E.L.J.) Touro University College of Osteopathic Medicine, Vallejo, California (J.H.S.) Utah State University, Taylorsville, Utah (L.P.) Acknowledgment: The authors thank Sarah Bradley; Matt Petersen; and Erika Gebel Berg, PhD, for their invaluable assistance in the reviewing and editing of this manuscript. The full Standards of Medical Care in Diabetes2018 was developed by the ADA's Professional Practice Committee: Rita R. Kalyani, MD, MHS (Chair); Christopher Cannon, MD; Andrea L. Cherrington, MD, MPH; Donald R. Coustan, MD; Ian de Boer, MD, MS; Hope Feldman, CRNP, FNP-BC; Judith Fradkin, MD; David Maahs, MD, PhD; Melinda Maryniuk, Med, RD, CDE; Medha N. Munshi, MD; Joshua J. Neumiller, PharmD, CDE; and Guillermo E. Umpierrez. ADA staff support includes Erika Gebel Berg, PhD; Tamara Darsow, PhD; Matt Petersen; Sacha Uelmen, RDN, CDE; and William T. Cefalu, MD. Disclosures: Dr. Chamberlain reports other support from Novo Nordisk, Sanofi Aventis, Janssen, and Merck outside the submitted work. Dr. Johnson reports personal fees from Novo Nordisk, Medtronic, and Sanofi outside the submitted work. Dr. Rhinehart reports employment with and stock ownership in Glytec. Dr. Shubrook reports personal fees from Novo Nordisk, Lilly Diabetes, and Intarcia outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0222 . Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that he Continue reading >>

A Summary Of Adas Recent 2018 Standards Of Medical Care In Diabetes

A Summary Of Adas Recent 2018 Standards Of Medical Care In Diabetes

Access , CDE , Cost of Care , Diabetes , Diabetes Education , Diabetes Management , Healthcare Management , Support , Type 1 Diabetes , Type 2 Diabetes , medical care For diabetes healthcare workers, part of ringing in the new year is reviewing the American Diabetes Association (ADA) Updated Diabetes Standards of Medical Care. Each year, a professional practice committee reviews evidence that has come out since the previous edition, providing recommendations for best practices in diabetes care. For those who have not yet had a chance to review the 2018 Standards, here is the cliff notes version, particularly as the updates relate to Certified Diabetes Educators (CDEs). The first update relates to the Standards of Care document overall. While this document will continue to be updated annually, there will now be an online version that is updated more frequently as needed (Professional.diabetes.org/SOC). In addition, the ADA will begin accepting proposals from the community for statements, consensus reports, scientific reviews, etc. CDEs would benefit from this opportunity to suggest topics for in-depth review that will further the evidence related to our effective support for patient self-management. The Standards of Care includes 15 chapters, to provide a comprehensive overview of evidence-based management of diabetes. While there are no major changes in the 2018 version, there are minor updates worth noting. Chapter 1 of the document, previously entitled Strategies for Improving Care, has been renamed Promoting Health and Reducing Disparities. This chapter includes a new recommendation that providers consider the burden of treatment and the self-efficacy of patients when recommending treatments. This chapter also discusses the importance of tailoring diabetes treatment Continue reading >>

Standards Of Medical Care In Diabetes—2018

Standards Of Medical Care In Diabetes—2018

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC. At least annual monitoring for the development of diabetes in those with prediabetes is suggested. E Patients with prediabetes should be referred to an intensive behavioral lifestyle intervention program modeled on the Diabetes Prevention Program to achieve and maintain 7% loss of initial body weight and increase moderate-intensity physical activity (such as brisk walking) to at least 150 min/week. A Technology-assisted tools including Internet-based social networks, distance learning, and mobile applications that incorporate bidirectional communication may be useful elements of effective lifestyle modification to prevent diabetes. B Given the cost-effectiveness of diabetes prevention, such intervention programs should be covered by third-party payers. B Screening for prediabetes and type 2 diabetes risk through an informal assessment of risk factors (Table 2.3) or with an assessment tool, such as the American Diabetes Association risk test (Fig. 2.1), is recommended to guide providers on whether perfor Continue reading >>

Connect: The Official News Magazine Of Asmbs

Connect: The Official News Magazine Of Asmbs

The American Diabetes Association (ADA) continues to recommend metabolic surgery to treat type 2 diabetes in patients with severe obesity (BMI>40), regardless the level of glycemic control or complexity of glucose-lowering regimens. This is among the treatment strategies included in the ADAs Standards of Medical Care in Diabetes 2018 , issued this month. The standards also say metabolic surgery should be an option for those with BMI 30.0 to 34.9, when hyperglycemia is inadequately controlled despite lifestyle and optimal medical therapy. "The Standards of Care are the primary resource for the optimal management of diabetes and include updated guidelines for diabetes diagnosis and for evidence-based prevention of diabetes and diabetes-related complications," said William T. Cefalu MD, ADAs chief scientific, medical and mission officer in a news release. The standards note strong and consistent evidence that managing obesity can delay the progression of prediabetes to type 2 diabetes and may be beneficial in the treatment of It provides recommendations on lifestyle interventions including diet, physical activity, and behavioral therapy, and pharmacotherapy for obesity, though noting that pharmacological treatment has been limited by low adherence, modest efficacy, adverse effects, and weight regain after medication cessation. The recommendations on metabolic surgery conclude that the safety of operations has improved significantly over the last two decades, with morbidity declining dramatically and mortality rates now similar to cholecystectomy or hysterectomy. Metabolic surgery should be recommended as an option to treat type 2 diabetes in appropriate surgical candidates with BMI40 kg/m2 (BMI37.5 kg/m2 in Asian Americans), regardless of the level of glycemic control or Continue reading >>

Ada’s 2018 Updates To Standards Of Medical Care In Diabetes

Ada’s 2018 Updates To Standards Of Medical Care In Diabetes

New guidelines address data-driven technology and humanizing diabetes care. The American Diabetes Association (ADA) just released its 2018 Standards of Medical Care in Diabetes. Since 1989, the organization has provided annual updates to keep current with research, technology, and treatments for both Type 1 and Type 2 Diabetes. The latest changes reflect an emerging reality for diabetes care in the twenty-first century: data-driven technology is increasingly integral in the management of the disease. sponsor The 2018 guide recognizes the enormous benefit of emerging technologies, such as continuous glucose monitoring (CGM) systems and automated insulin delivery systems. It provides more extensive-than-ever guidelines to providers on these technologies, and it expands recommendations for the use of such systems. For instance, the ADA now recommends the use of CGM for all adults with Type 1 Diabetes who are not achieving glycemic targets. (Previously, the technology was only recommended to persons 25 and above.) The ADA has also added text to inform providers about a recently approved intermittent (“flash”) CGM device and about CGM devices that no longer require manual confirmation of blood glucose for treatment decisions. Read “Five Quick-takes from the ADA 77th Scientific Sessions” There are suggestions for using analytics from devices to tailor and individualize treatment decisions. For instance, physicians are encouraged to use data to assess an individual’s hypoglycemic and hyperglycemic risks, and, in turn, adjust A1C goals. In addition to recognizing the value of such developments, the ADA is mindful that many patients today feel as though they are being scrutinized and/or reduced to a pile of statistics. Consequently, the 2018 manual includes extensive r Continue reading >>

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