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Standards Of Medical Care In Diabetes 2018 Diabetes Care 2018 40 1 ): S1 S135

Diabetes Management Guidelines: What Pharmacists Should Know

Diabetes Management Guidelines: What Pharmacists Should Know

Written with Marilyn Bulloch, PharmD, and Madeleine King, Erinne Weber, and Octavian Barnett, PharmD Candidates 2018 Harrison School of Pharmacy, Auburn University. The American Diabetes Association (ADA) updated the Standards of Medical Care in Diabetes in January 2017.1 With this update, the ADA addressed aspects of care including lifestyle management, self-management, comorbidities, and complications with diabetes. Reference 1. Cefalu, WT Bakris G, Blonde L, et al. Standards of Medical Care in Diabetes-2017. Diabetes Care. 2017 January;40(1):S1–S135. The newest lifestyle management recommendation states that if a patient will be sitting for long periods of time, such as working at a desk or watching television, short periods of physical activity, such as briefly standing or walking around, should occur every 30 minutes. These guidelines also provided a new definition of clinically significant hypoglycemia at a blood glucose <54 mg/dL. However, the glucose level of concern associated with hypoglycemia continues to be defined as < 70 mg/dL. The guidelines provide a few updates to the pharmacologic management of the disease. When using metformin long-term, it is recommended to periodically monitor B12 levels due to an association of vitamin B12 deficiency with metformin which is known to occur with long-term use and higher daily doses of metformin. The guidelines also recommend that empagliflozin or liraglutide be considered in patients with cardiovascular disease to reduce the risk of mortality. Studies showed a reduction of myocardial infarction, stroke, and cardiovascular death by 14% when empagliflozin was used and by 13% when liraglutide was used. Pregnant patients with diabetes and chronic hypertension should be managed to achieve a goal blood pressure of 120– Continue reading >>

American Diabetes Association 2017 Update: A Brief Review Of New Evidence

American Diabetes Association 2017 Update: A Brief Review Of New Evidence

American Diabetes Association 2017 Update: A Brief Review of New Evidence Jennifer Hiemenz, PharmD, Coborn’s Pharmacy- Little Falls, MN The American Diabetes Association (ADA) closely examines scientific literature and makes recommendations to help treat diabetes consistently and effectively. The ADA recently released an update on the Standards of Medical Care in Diabetes. This document serves all shareholders of the diabetes community. A Professional Practice Committee completes an extensive literature search, evaluates the quality of new evidence and provides recommendations for review with the Board of Directors. Accepted recommendations are published on an annual basis. The following recommendations were emphasized in the 2017 update. Assessing Comorbidities: A recent meta-analysis concluded that poor sleep quality and sleeping for long or short intervals can negatively impact blood glucose control in patients with type 2 diabetes. An increase of A1C weighted mean difference of 0.13% to 0.35% was reported in the three sleep abnormalities. Due to these findings, the ADA recommends assessment of sleep patterns, including duration, as part of the comprehensive review of type 2 diabetes patients. Other important comorbidities to assess and treat include autoimmune diseases, HIV, anxiety disorders, depression, eating disorders and serious mental illness as they can impede diabetes management. Staging Type 1 Diabetes: Three distinct stages of type 1 diabetes can be identified. A clear link has been established between the presence of autoantibodies and progression to clinical hyperglycemia and diabetes. The first stage involves detectable levels of beta-cell autoantibodies; however, the patient is presymptomatic and blood glucose levels are normal. The second stage invo Continue reading >>

Diabetes: Blood Sugar Levels

Diabetes: Blood Sugar Levels

Keeping your blood sugar in a target range reduces your risk of problems such as diabetic eye disease ( retinopathy ), kidney disease ( nephropathy ), and nerve disease ( neuropathy ). Some people can work toward lower numbers, and some people may need higher goals. For example, some children and adolescents with type 1 or type 2 diabetes, people who have severe complications from diabetes, people who may not live much longer, or people who have trouble recognizing the symptoms of low blood sugar may have a higher target range. And some people, such as those who are newly diagnosed with diabetes or who don't have any complications from diabetes, may do better with a lower target range. Work with your doctor to set your own target blood sugar range. This will help you achieve the best control possible without having a high risk of hypoglycemia. The American Diabetes Association (ADA) and American Academy of Pediatrics (AAP) suggest the following A1c and blood glucose ranges as a general guide. footnote 1 , footnote 2 , footnote 3 , footnote 4 Children of any age with type 2 diabetes and most adults with type 1 or type 2 diabetes (non-pregnant) Before meals: 80 to 130 milligrams per deciliter (mg/dL) 1 to 2 hours after meals: Lower than 180 mg/dL Youth (younger than 18 years old) with type 1 diabetes Women with type 1 or type 2 diabetes who become pregnant 1 to 2 hours after meals: 120 to 140 mg/dL or lower 1 to 2 hours after meals: 120 to 140 mg/dL or lower Health Tools help you make wise health decisions or take action to improve your health. Actionsets are designed to help people take an active role in managing a health condition. American Academy of Pediatrics (2013). Clinical Practice Guideline: Management of newly diagnosed type 2 diabetes mellitus (T2DM) in childr Continue reading >>

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 >>

Course References - #92452: Type 2 Diabetes In Youth: A Growing Concern - Netce

Course References - #92452: Type 2 Diabetes In Youth: A Growing Concern - Netce

1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017: Estimates of Diabetes and Its Burden in the United States. Atlanta, GA: U.S. Department of Health and Human Services; 2017. 2. American Diabetes Association. Statistics About Diabetes. Available at . Last accessed January 11, 2018. 3. Copeland KC, Silverstein J, Moore KR, et al. Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents. Pediatrics. 2013;131;364-382. 4. International Society for Pediatric and Adolescent Diabetes. ISPAD Clinical Practice Consensus Guidelines 2014. Available at . Last accessed January 11, 2018. 5. Fu J, Prasad HC. Changing epidemiology of metabolic syndrome and type 2 diabetes in Chinese youth. Curr Diab Rep. 2014;14:447. 6. Prasad AN. Type 2 diabetes mellitus in young need for early screening. Indian Pediatr. 2011;48:683-688. 7. Clinical Endocrinology News. Pediatric Type 2 Diabetes Guidelines Stress Metformin. Available at . Last accessed January 11, 2018. 8. Ferguson SC, Blane A, Wardlaw J, et al. Influence of an early-onset age of type 1 diabetes on cerebral structure and cognitive function. Diabetes Care. 2005;28(6):1431-1437. 9. Northam EA, Rankins D, Lin A, et al. Central nervous system function in youth with type 1 diabetes 12 years after disease onset. Diabetes Care. 2009;32(3):445-450. 10. Hershey T, Perantie DC, Wu J, Weaver PM, Black KJ, White NH. Hippocampal volumes in youth with type 1 diabetes. Diabetes. 2010;59(1):236-241. 11. American Diabetes Association. The Staggering Costs of Diabetes. Available at . Last accessed January 11, 2018. 12. Centers for Disease Control and Prevention. Childhood Obesity Facts. Available at . Last accessed January 11, 2018. 13. Spiegel GA, Evert A, Shea L. Role of health e Continue reading >>

: The Amedeo Literature Guide

: The Amedeo Literature Guide

Comment on Li et al. Time Trends of Dietary and Lifestyle Factors and Their Potential Impact on Diabetes Burden in China. Diabetes Care 2017;40:1685-1694. Comment on Pareek et al. Enhanced Predictive Capability of a 1-Hour Oral Glucose Tolerance Test: A Prospective Population-Based Cohort Study. Diabetes Care 2018;41:171-177. Response to Comment on Chan et al. FGF23 Concentration and APOL1 Genotype Are Novel Predictors of Mortality in African Americans With Type 2 Diabetes. Diabetes Care 2018;41:178-186. Comment on Chan et al. FGF23 Concentration and APOL1 Genotype Are Novel Predictors of Mortality in African Americans With Type 2 Diabetes. Diabetes Care 2018;41:178-186. Effect of the Duodenal-Jejunal Bypass Liner on Glycemic Control in Patients With Type 2 Diabetes With Obesity: A Meta-analysis With Secondary Analysis on Weight Loss and Hormonal Changes. OWOLABI MO, Yaria JO, Daivadanam M, Makanjuola AI, et al Gaps in Guidelines for the Management of Diabetes in Low- and Middle-Income Versus High-Income Countries-A Systematic Review. PubMed Text format Abstract available NUCKOLS TK, Keeler E, Anderson LJ, Green J, et al Economic Evaluation of Quality Improvement Interventions Designed to Improve Glycemic Control in Diabetes: A Systematic Review and Weighted Regression Analysis. PANTALONE KM, Misra-Hebert AD, Hobbs TM, Ji X, et al Clinical Inertia in Type 2 Diabetes Management: Evidence From a Large, Real-World Data Set. Diabetes Care. 2018 Apr 20. pii: dc18-0116. doi: 10.2337/dc18-0116. GRAFF RE, Sanchez A, Tobias DK, Rodriguez D, et al Type 2 Diabetes in Relation to the Risk of Renal Cell Carcinoma Among Men and Women in Two Large Prospective Cohort Studies. Diabetes Care. 2018 Apr 20. pii: dc17-2518. doi: 10.2337/dc17-2518. PubMed Text format Abstract available HEDD Continue reading >>

Diabetes: Blood Sugar Levels

Diabetes: Blood Sugar Levels

Keeping your blood sugar in a target range reduces your risk of problems such as diabetic eye disease ( retinopathy ), kidney disease ( nephropathy ), and nerve disease ( neuropathy ). Some people can work toward lower numbers, and some people may need higher goals. For example, some children and adolescents with type 1 or type 2 diabetes, people who have severe complications from diabetes, people who may not live much longer, or people who have trouble recognizing the symptoms of low blood sugar may have a higher target range. And some people, such as those who are newly diagnosed with diabetes or who don't have any complications from diabetes, may do better with a lower target range. Work with your doctor to set your own target blood sugar range. This will help you achieve the best control possible without having a high risk of hypoglycemia. The American Diabetes Association (ADA) and American Academy of Pediatrics (AAP) suggest the following A1c and blood glucose ranges as a general guide. footnote 1 , footnote 2 , footnote 3 , footnote 4 Children of any age with type 2 diabetes and most adults with type 1 or type 2 diabetes (non-pregnant) Before meals: 80 to 130 milligrams per deciliter (mg/dL) 1 to 2 hours after meals: Lower than 180 mg/dL Youth (younger than 18 years old) with type 1 diabetes Women with type 1 or type 2 diabetes who become pregnant 1 to 2 hours after meals: 120 to 140 mg/dL or lower 1 to 2 hours after meals: 120 to 140 mg/dL or lower Health Tools help you make wise health decisions or take action to improve your health. Actionsets are designed to help people take an active role in managing a health condition. American Academy of Pediatrics (2013). Clinical Practice Guideline: Management of newly diagnosed type 2 diabetes mellitus (T2DM) in childr Continue reading >>

Diabetes: Blood Sugar Levels

Diabetes: Blood Sugar Levels

Keeping your blood sugar in a target range reduces your risk of problems such as diabetic eye disease ( retinopathy ), kidney disease ( nephropathy ), and nerve disease ( neuropathy ). Some people can work toward lower numbers, and some people may need higher goals. For example, some children and adolescents with type 1 or type 2 diabetes, people who have severe complications from diabetes, people who may not live much longer, or people who have trouble recognizing the symptoms of low blood sugar may have a higher target range. And some people, such as those who are newly diagnosed with diabetes or who don't have any complications from diabetes, may do better with a lower target range. Work with your doctor to set your own target blood sugar range. This will help you achieve the best control possible without having a high risk of hypoglycemia. The American Diabetes Association (ADA) and American Academy of Pediatrics (AAP) suggest the following A1c and blood glucose ranges as a general guide. footnote 1 , footnote 2 , footnote 3 , footnote 4 Children of any age with type 2 diabetes and most adults with type 1 or type 2 diabetes (non-pregnant) Before meals: 80 to 130 milligrams per deciliter (mg/dL) 1 to 2 hours after meals: Lower than 180 mg/dL Youth (younger than 18 years old) with type 1 diabetes Women with type 1 or type 2 diabetes who become pregnant 1 to 2 hours after meals: 120 to 140 mg/dL or lower 1 to 2 hours after meals: 120 to 140 mg/dL or lower Health Tools help you make wise health decisions or take action to improve your health. Actionsets are designed to help people take an active role in managing a health condition. American Academy of Pediatrics (2013). Clinical Practice Guideline: Management of newly diagnosed type 2 diabetes mellitus (T2DM) in childr Continue reading >>

Diabetes: Blood Sugar Levels

Diabetes: Blood Sugar Levels

Keeping your blood sugar in a target range reduces your risk of problems such as diabetic eye disease ( retinopathy ), kidney disease ( nephropathy ), and nerve disease ( neuropathy ). Some people can work toward lower numbers, and some people may need higher goals. For example, some children and adolescents with type 1 or type 2 diabetes, people who have severe complications from diabetes, people who may not live much longer, or people who have trouble recognizing the symptoms of low blood sugar may have a higher target range. And some people, such as those who are newly diagnosed with diabetes or who don't have any complications from diabetes, may do better with a lower target range. Work with your doctor to set your own target blood sugar range. This will help you achieve the best control possible without having a high risk of hypoglycemia. The American Diabetes Association (ADA) and American Academy of Pediatrics (AAP) suggest the following A1c and blood glucose ranges as a general guide. footnote 1 , footnote 2 , footnote 3 , footnote 4 Children of any age with type 2 diabetes and most adults with type 1 or type 2 diabetes (non-pregnant) Before meals: 80 to 130 milligrams per deciliter (mg/dL) 1 to 2 hours after meals: Lower than 180 mg/dL Youth (younger than 18 years old) with type 1 diabetes Women with type 1 or type 2 diabetes who become pregnant 1 to 2 hours after meals: 120 to 140 mg/dL or lower 1 to 2 hours after meals: 120 to 140 mg/dL or lower Health Tools help you make wise health decisions or take action to improve your health. Actionsets are designed to help people take an active role in managing a health condition. American Academy of Pediatrics (2013). Clinical Practice Guideline: Management of newly diagnosed type 2 diabetes mellitus (T2DM) in childr Continue reading >>

Diabetes: Blood Sugar Levels

Diabetes: Blood Sugar Levels

Keeping your blood sugar in a target range reduces your risk of problems such as diabetic eye disease ( retinopathy ), kidney disease ( nephropathy ), and nerve disease ( neuropathy ). Some people can work toward lower numbers, and some people may need higher goals. For example, some children and adolescents with type 1 or type 2 diabetes, people who have severe complications from diabetes, people who may not live much longer, or people who have trouble recognizing the symptoms of low blood sugar may have a higher target range. And some people, such as those who are newly diagnosed with diabetes or who don't have any complications from diabetes, may do better with a lower target range. Work with your doctor to set your own target blood sugar range. This will help you achieve the best control possible without having a high risk of hypoglycemia. The American Diabetes Association (ADA) and American Academy of Pediatrics (AAP) suggest the following A1c and blood glucose ranges as a general guide. footnote 1 , footnote 2 , footnote 3 , footnote 4 Children of any age with type 2 diabetes and most adults with type 1 or type 2 diabetes (non-pregnant) Before meals: 80 to 130 milligrams per deciliter (mg/dL) 1 to 2 hours after meals: Lower than 180 mg/dL Youth (younger than 18 years old) with type 1 diabetes Women with type 1 or type 2 diabetes who become pregnant 1 to 2 hours after meals: 120 to 140 mg/dL or lower 1 to 2 hours after meals: 120 to 140 mg/dL or lower Health Tools help you make wise health decisions or take action to improve your health. Actionsets are designed to help people take an active role in managing a health condition. American Academy of Pediatrics (2013). Clinical Practice Guideline: Management of newly diagnosed type 2 diabetes mellitus (T2DM) in childr Continue reading >>

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