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Standards Of Medical Care In Diabetes 2018 Abridged For Primary Care Providers

2018 American Diabetes Associations Practice Standards Recommend Glp-1 Injectables.

2018 American Diabetes Associations Practice Standards Recommend Glp-1 Injectables.

2018 American Diabetes Associations Practice Standards Recommend GLP-1 Injectables. The benefits extend beyond glucose control to protecting cardiovascular health and helping some people lose weight. In the thirteen years since GLP (glucagon-like peptide) receptor agonists first appeared, they have gained wide acceptance among clinicians whose T2D patients have had difficulty meeting their A1c targets on metformin monotherapy (Lifestyle Management + Metformin, as the American Diabetes Association Professional Practice Committee defines it). All the drugs in the GLP-1 class are incretin mimetics, meaning they work by responding to glucose in the digestive tract to stimulate sensitivity to, and secretion of, insulin when needed, and secretion of glucagon when glucose levels drop, and to suppress release of glucose and lipids from the liver into the bloodstream. In television spots the maker of one of the products in this class of drugs, Eli Lily, describes its GLP-1 product Trulicity as one that activates whats within the body to control blood glucose, and thats a pretty handy way to understand it all that a GLP-1 agonist helps an underperforming pancreas by optimizing beta cell function. GLP-1s are not indicated as a first-line therapy for T2D, the way that metformin is, as an adjunct to diet and exercise. With the publication of the ADAs 2018 Standards of Medical Care in Diabetes came a major addition to the Antihyperglycemic Therapy decision protocol: a GLP-1 as additional agent to reduce risk of death or major adverse cardiovascular complications for patients with established ASCVD, or arteriosclerotic cardiovascular disease. An accompanying recommendation (See Standards 8 p. S75) states that for such patients therapy should begin with lifestyle management and metfor Continue reading >>

Diabetes Management In Older Adults With Cardiovascular Disease

Diabetes Management In Older Adults With Cardiovascular Disease

Diabetes Management in Older Adults with Cardiovascular Disease Editor's Note: Please see the associated Patient Case Quiz on the same topic here . Older adults with type 2 diabetes mellitus are a large, heterogeneous and growing population who are at high risk for adverse cardiovascular events.1 Unfortunately, there is a paucity of randomized control data on cardiovascular outcomes in patients with diabetes who are over the age of 80. Mean age of participants in the three major relevant trials, VADT (Veterans Affairs Diabetes Trial), ACORRD (Action to Control Cardiovascular Risk in Diabetes) and ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation), were 60, 62 and 66 years respectively.2-4 The ASCVD risk calculator, which helps clinicians make decisions about prescribing statins and aspirin based on a patient's cardiovascular risk factors, including diabetes, is based on a pooled cohort analysis from five studies of patients aged 40-79.5 Therefore caring for patients over age 80 requires an individualized rather than guideline driven approach.6 Choosing Wisely , a collective initiative of multiple professional societies that focuses on reducing medical tests and treatment that may be harmful or of marginal medical value, supports this patient-based approach. In many older patients, the risks of over-treating diabetes outweigh the benefits. The American Geriatrics Society recommends a goal a1c of 7.5-8% in older patients with moderate comorbidities and life expectancy less than 10 years;7 the American Diabetes Association recommends a more relaxed goal of 8-8.5% for older patients with complex medical issues.1 These recommendations are supported by evidence that low a1c targets did not reduce risk of macrovascular complicat 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 >>

Standards Of Medical Care In Diabetes-2017 Abridged For Primary Care Providers

Standards Of Medical Care In Diabetes-2017 Abridged For Primary Care Providers

Standards of Medical Care in Diabetes2017 capabilities, duplicates services, and is TABLE 1. Criteria for the Diagnosis of Diabetes FPG 126 mg/dL (7.0 mmol/L). Fasting is dened as no caloric intake for at 2-h plasma glucose 200 mg/dL (11.1 mmol/L) during an OGTT. The test should be performed as described by the World Health Organization, using a glucose load containing the equivalent of 75 g anhydrous glucose A1C 6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP cer tied and standardized to the Diabetes In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose 200 mg/dL (11.1 mmol/L). *In the absence of unequivocal hyperglycemia, results should be conrmed a b r i d g e d standards of c a r e 2017 cian assistants, nurses, dietitians, exer- TABLE 2. Criteria for Testing for Diabetes or Prediabetes in 1. Testing should be considered in over weight or obese (BMI 25 kg/m2 or 23 kg/m2 in Asian Americans) adults who have one or more of the A1C 5.7% (39 mmol/mol), impaired glucose tolerance, or impaired High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacic Islander) Hypertension (140/90 mmHg or on therapy for hypertension) HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglycer- Other clinical conditions associated with insulin resistance (e.g., 2. For all patients, testing should begin at age 45 years. 3. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly) and TABLE 3. Referrals for Initial Care Management Eye care professional for annual dilated eye exam Family planning for women of 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 >>

American Diabetes Association Releases Diabetes Guidelines For Primary-care Providers

American Diabetes Association Releases Diabetes Guidelines For Primary-care Providers

American Diabetes Association releases diabetes guidelines for primary-care providers American Diabetes Association releases diabetes guidelines for primary-care providers HealthDay News An abridged version of the 2015 Standards of Medical Care in Diabetes has been produced for primary-care practitioners. The guidelines were published in Clinical Diabetes. The condensed guidelines, produced by researchers from the American Diabetes Association (ADA) and the ADA Primary Care Advisory Group (PCAG), specifically focus on evidence-based recommendations for primary-care providers (PCPs). Patient-centered communication that incorporates patient preferences, addresses cultural barriers to care, and assesses literacy and numeracy was identified as a key strategy for improving diabetes care. Care should be aligned with components of the Chronic Care Model to facilitate productive interactions between a prepared proactive practice team and informed, activated patients, emphasized the researchers. The report focuses on diabetes care concepts, which include patient centeredness, diabetes across the life span, and advocacy for patients with diabetes. Particular attention is devoted to the foundations of diabetes care, including lifestyle management; glycemic treatment and therapeutic targets; prediabetes; the diagnosis and treatment of micro- and macrovascular complications; and use of insulin therapy in type 2 diabetes. "Keeping up with the ever-changing guidelines can be very hard for busy primary-care providers, who are not merely treating one condition, but rather many conditions every single day," PCAG Chair Jay Shubrook, DO, said in a statement. "The abridged Standards are a second-level synthesis of the most important diabetes recommendations." Continue reading >>

Ada 2018 Abridged Standards: Update For Primary Care - Medscape Diabetes & Endocrinology Podcast (podcast)

Ada 2018 Abridged Standards: Update For Primary Care - Medscape Diabetes & Endocrinology Podcast (podcast)

Medscape Diabetes & Endocrinology Podcast MP3 • Episode home • Series home • Public Feed Discovered by Player FM and our community copyright is owned by the publisher, not Player FM, and audio streamed directly from their servers. What are the key changes in the 2018 ADA Abridged Standards for Diabetes Care that primary care clinicians should know? 56 episodes available.A new episode about every5 daysaveraging 7 mins duration. The ACP reviewed relevant studies but came to conclusions 'not germane to the way we treat patients with type 2 diabetes today,' says Dr Anne Peters. Dr Kuchay discusses his findings from the E-LIFT study. Dr Peters clarifies the pros and cons of the Dexcom and FreeStyle Libre continuous glucose monitors for patients with diabetes. Drs Shubrook and Chamberlain discuss cardiovascular risk reduction associated with SGLT-2 inhibitors and GLP-1 agonists in T2D, and advise clinicians to 'be aware.' Dr JoAnn Manson offers clinicians a new resource to guide discussions with patients about vitamins and supplements. An effort to encourage individualized treatment choices may muddy the therapy waters, says Dr Peters. Dr Tyree Winters stresses the importance of identifying at-risk kids and screening often, as much as annually, to be sure that early-stage type 2 diabetes is not missed. Dr Alan Jacobs reports on a recent study suggesting that antihypertensive therapy might not return microcirculation to normal. Drs O'Donoghue and McGuire discuss the data on the various SGLT2 inhibitors and GLP1 receptor agonists and when to consider prescribing them to your patients with diabetes. Hormone therapy must be discussed and individualized for each patient in order to achieve the best outcome for treating menopause. Dr Chodak reviews a 'provocat Continue reading >>

Journaltocs

Journaltocs

Authors: Mayer B. Davidson; Petra Duran; S. Joshua Davidson; Martin Lee Abstract: IN BRIEF Insulin dose adjustment decisions in 20 simulated patients by nine primary care physicians (PCPs) and nine endocrinologists were compared to the algorithms used in a diabetes program in a large safety-net clinic. The number of dose changes was similar in the PCP and endocrinologist groups; however, the amounts of the dose changes in the PCP group were significantly closer to the diabetes program algorithms than the amounts in the endocrinologist group. Time constraints, rather than lack of ability, seem to be the major barrier to PCPs treating patients with insulin. Authors: Kayla Ward; Rhonda S. Eustice; Ann D. Nawarskas; Nina D. Resch Abstract: IN BRIEF This pilot program evaluates the impact of telephone versus mixed modalities of care on A1C. A retrospective chart review was conducted to evaluate mean baseline and follow-up A1C values for all patients who received telephone care, video-conferencing, or in-person clinic appointments with certified diabetes educators at a single, rural U.S. Department of Veterans Affairs clinic. The results of this evaluation showed that glycemic control was improved both in patients who received diabetes management through telephone care alone and in those who received mixed modalities of care. Authors: Robert Engler; Timothy L. Routh; Joseph Y. Lucisano Abstract: IN BRIEF A patient-centered approach to device design can provide important advantages in optimizing diabetes care technology for broadened adoption and improved adherence. Results from two surveys of people with diabetes and the parents of children with diabetes (n = 1,348) regarding continuous glucose monitoring (CGM) devices reveal the importance of the concept of user burden in p Continue reading >>

Ada 2018 Abridged Standards Of Medical Care In Diabetes: Update For Primary Care

Ada 2018 Abridged Standards Of Medical Care In Diabetes: Update For Primary Care

Jay H. Shubrook, DO: Good morning. This is Jay Shubrook, family physician and diabetologist at Touro University, California. We are continuing our series on Everyday Diabetes: Practical Management for Primary Care . I am delighted to have with me today Eric Johnson, associate professor in family medicine at the University of North Dakota School of Medicine, and assistant director of the Altru Diabetes Center. We are talking about the 2018 "Abridged Standards of Care" from the American Diabetes Association (ADA) . Eric, who is the incoming chair of the Primary Care Advisory Group of the ADA, is responsible for this document. Welcome, Eric. We're glad to have you onboard. Eric L. Johnson, MD: Thank you, Jay. It's great to be here with you today. Dr Shubrook: Eric, what is the "Abridged Standards of Care" and why is it important for primary care? Dr Johnson: The "Abridged Standards of Care" is a document prepared by the Primary Care Advisory Group. The idea is to take the full "Standards," a very large document with all current and pertinent information, and boil it down into a 20-page document that is more useful for a primary care practitioner. This seems to be a very usable and popular format. Dr Shubrook: It is a very important document; it's like the Cliffs Notes of the "Standards of Care." This is the meat, the things that would be most important to primary care. Is that correct? Dr Johnson: I think that's a good description. Dr Shubrook: Where can we find the "Abridged Standards of Care"? Dr Johnson: They are published and released on the same day as the larger, complete "Standards of Care" document, and both are available in full text on the ADA website . Dr Shubrook: What are some of the key changes or key content that you think are important in the 2018 "Abridge Continue reading >>

Top 5 Changes To The Ada Standards Of Care In Diabetes

Top 5 Changes To The Ada Standards Of Care In Diabetes

A synopsis of the 2016 American Diabetes Association (ADA) Standards of Medical Care in Diabetes was published online ahead of print in the Annals of Internal Medicine. EndocrineWeb spoke with the synopsis authors James J. Chamberlain, MD and Annie Neuman, PA-C about the top 5 changes in the guidelines that endocrinologists, primary care providers, and other health care practitioners should know about. Dr. Chamberlain is Medical Director for Diabetes Services at St. Mark’s Hospital and St. Mark’s Diabetes Center in Salt Lake City, Utah. Ms. Neuman is a physician assistant in the Department of Internal Medicine at St. Mark’s Hospital and St. Mark’s Diabetes Center. Q: What are the top 5 changes to the ADA Standards of Medical Care in Diabetes that endocrinologists and primary care physicians (PCPs) should know about? A: First, we believe it is important for PCPs to continue to stress lifestyle modification, including diet control and increased physical activity. New phone apps and referrals to diabetes education can help achieve these goals. We would stress the importance of using multiple oral agents, especially at diagnosis, for patients with hemoglobin A1C levels >9%. Most patients in this category will require at least two medications to achieve satisfactory glycemic control. Aggressive atherosclerotic cardiovascular disease treatment and control is imperative to reduce morbidity and mortality. Patients with diabetes over the age of 40 years need to be treated with statin therapy if tolerated. We are now encouraging earlier referrals to nephrology for diabetes patients with declining kidney function and/or increasing or severe albuminuria. Earlier evaluation and treatment may slow the rate of progression to end-stage renal disease. Lastly, it is important to Continue reading >>

Ada 2018 Atencao Primaria

Ada 2018 Atencao Primaria

C L I N I C A L D I A B E T E S 1E D I T O R I A LP O S I T I O N S TAT E M E N TThe American Diabetes Associ-ations (ADAs) Standards of Medical Care in Diabetes arepublished each year in a supplementto the January issue of Diabetes Care.The ADAs Professional PracticeCommittee develops the Standardsand updates them annually, or morefrequently online should it determinethat new evidence or regulatory chang-es (e.g., drug approvals, label changes)merit immediate incorporation. TheStandards include the most currentevidence-based recommendations fordiagnosing and treating adults andchildren with diabetes. ADAs grad-ing system uses A, B, C, or E to showthe evidence level that supports eachrecommendation. AClear evidence from well-conducted, generalizable random-ized controlled trials that are ade-quately powered BSupportive evidence fromwell-conducted cohort studies CSupportive evidence frompoorly controlled or uncontrolledstudies EExpert consensus or clinicalexperienceThis is an abridged version ofthe Standards containing the evi-dence-based recommendations mostpertinent to primary care. The tablesand figures have been renumberedfrom the original document to matchthis version. All of the recommenda-tions (bulleted text) are precisely thesame as in the full Standards of Care.The complete 2018 Standards of Caredocument, including all supportingreferences, is available at professional.diabetes.org/standards.IMPROVING CARE ANDPROMOTING HEALTH INPOPULATIONSOver the past 10 years, the proportionof patients with diabetes who achieverecommended A1C, blood pressure,and LDL cholesterol levels has in-creased. The mean A1C nationallyamong people with diabetes has de-clined from 7.6% (60 mmol/mol) in19992002 to 7.2% (55 mmol/mol)in 20072010 based on the NationalHealth and Nutrition Exa Continue reading >>

Diabetes Resources - Michigan Primary Care Association

Diabetes Resources - Michigan Primary Care Association

The resources on this page are organized by presentations , resource documents (reports, issue briefs, fact sheets, websites), and tools and templates (spreadsheets, modifiable Word documents, job descriptions). If you don't find what you are looking for you can search by keyword using the search field at the top of this page. Population Health Management (Diabetes and Hypertension with EHR Technology 2015 | Slideshare | Source: Michigan Primary Care Association Hypertension and diabetes are the biggest contributors to heart attacks and strokes, but are not managed as well as they could be. The tactical issue for physicians lies in the ongoing identification and management of patients who have hypertension and diabetes as well as uncovering those at risk or on the cusp that may not realize it.This webinar teaches providers how to utilize their existing EHR technology to help health care teams monitor and regulate this population. Practical Approaches to Enhance Diabetic Patient Engagement 2015 | Slideshare | Source: Michigan Primary Care Association This presentation will provide evidence-based, practical strategies for facilitating and enhancing shared decision-making and patient engagement to ease the burden and distress resulting from diabetes and its management. 2018 | PDF | Source: American Diabetes Association Diabetes Self-Management Education and Support in Type 2 Diabetes 2015 | PDF | Source: American Diabetes Association, the American Association of Diabetes Educators and the Academy of Nutrition and Dietetics Diabetesself-management education and supportprovides the foundation to help people withdiabetes to navigate these decisions and activities and hasbeen shown to improve health outcomes. 2014 | Slideshare | Source: Michigan Primary Care Association This Continue reading >>

Jd-perceptions Of Persons With Type 2 Diabetes Treated In Swedish Primary Health Care: Qualitative Study On Using Ehealth Services For Self-management Support | Berg | Jmir Diabetes

Jd-perceptions Of Persons With Type 2 Diabetes Treated In Swedish Primary Health Care: Qualitative Study On Using Ehealth Services For Self-management Support | Berg | Jmir Diabetes

Following the steps of the analysis should not be seen as a linear process, rather a process of going back and forth between the steps and between original data and analyzed data. All authors also discussed the interpretations within every step of the analysis until consensus was achieved [ 36 ]. The Regional Ethical Review Board at Ume University approved the study (Dnr 2014-179-31M) and was conducted according to the ethical principles described in the Helsinki Declaration [ 40 ]. Before giving informed consent, the participants received oral and written information. It was emphasized that participation was voluntary and that they could withdraw from the study at any time without giving explanation; they were also assured of confidentiality. The transcripts were made anonymous by removing personal information. In addition, quotations were made anonymous with small changes in wordings that did not alter their core meaning. A total of 5 categories within the domains Potentials and Concerns were identified in the analysis. The results were divided into 2 domains, 5 categories and 12 subcategories. Each subcategory is further enlightened by quotations from the original interviews in the following text. Within the domain Potentials, which referred to the positive perceptions of using digital health services as self-management support, the categories Involvement, Empowerment, and Security were highlighted. The importance of being involved in decisions about medication and in discussions about self-management and goalsfor example, blood sugar levelswere highlighted. Some had negative perceptions from previous health care contacts when health care professionals made decisions over their heads. The subcategories related to this category are Independence and Responsibility. In Continue reading >>

The Role Of Primary Care Providers In Managing Falls

The Role Of Primary Care Providers In Managing Falls

The Role of Primary Care Providers in Managing Falls assistant professor, Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. Address correspondence to Dr. Jamehl L. Demons, Sticht Center on Aging, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157 (jdemons{at}wakehealth.edu). professor, Department of Neurology, Wake Forest School of Medicine; senior policy advisor for innovations and transitional outcomes, Wake Forest School of Medicine, Winston-Salem, North Carolina. Falls threaten the ability of older adults to live independently in the community. Fortunately, national and state organizations have created tools that allow primary care providers to easily assess fall risk, and small changes in practice patterns can provide patients with the resources necessary to prevent falls, thus helping to reverse a costly, deadly epidemic. 2014 by the North Carolina Institute of Medicine and The Duke Endowment. North Carolina Medical Journal September-October 2014 vol. 75 no. 5 331-335 Continue reading >>

Abridged Diabetes Guidelines For Primary Care: 6 Noteworthy Changes

Abridged Diabetes Guidelines For Primary Care: 6 Noteworthy Changes

Abridged Diabetes Guidelines for Primary Care: 6 Noteworthy Changes American Diabetes Association. Standards of Medical Care in Diabetes2015. Abridged for Primary Care Providers. Clin Diabetes. 2015;33:97-111. More information, here. Contain evidence-based recommendations relevant to PCPs who care for patients with T2DM. The focus is on patient-centered communication that incorporates patient preferences, assesses literacy, numeracy, addresses cultural barriers to care. The guidelines also include updates, 6 of which are particularly important for primary care providers. Consider testing for diabetes and prediabetes in Asian Americans with a body mass index (BMI) of 23 kg/m2 or higher. This is a decrease from last year's recommendation of testing of individuals with a BMI of 25 kg/m2 or higher. Glycemic targets are now 80 to 130 mg/dL, which is higher than the target of 70 to 130 mg/dL that was recommended last year. An updated diabetes type 2 treatment algorithm includes newer therapies such as the DPP-4 inhibitors, GLP-1 receptor agonists, and the SGLT2 inhibitors. The initiation and intensification of statin therapy is now based on age and risk factors. This reflects a change from recommending treatment on the basis of cholesterol measurements to determining treatment based on risk stratification. Perform a foot exam on patients with diabetes at every visit, and not just annually, as was recommended last year (2014). The new A1C goal for children and adolescents is lower than 7.5%, regardless of age. This represents a lowering of the goal for children younger than 12 years. When a patient is not readily meeting treatment goals, reassessment is essential and may require close evaluation of patient-specific barriers, including: cultural issues, income, health literacy Continue reading >>

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