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Va Dod A1c Guidelines

Screening Detects Highly Prevalent Undiagnosed Diabetes And Prediabetes In Veterans Receiving Primary Care, But A1c Misclassifies Patients

Screening Detects Highly Prevalent Undiagnosed Diabetes And Prediabetes In Veterans Receiving Primary Care, But A1c Misclassifies Patients

Screening Detects Highly Prevalent Undiagnosed Diabetes and Prediabetes in Veterans Receiving Primary Care, but A1c Misclassifies Patients Screening to detect unrecogniz Screening to detect unrecognized dysglycemia is recommended, but the best methods to use and [ldquo]real world[rdquo] yield from screening in primary care are unknown. Since the quality of primary care in the VA is high, we examined the use of A1c for opportunistic screening at VA primary care visits.[br]Screening was offered to patients meeting NIDDK/ADA guidelines: without known diabetes, and with age [underline][gt][/underline]45 yr or BMI [underline][gt][/underline]25 kg/m[sup]2[/sup] with another risk factor. An OGTT identified hyperglycemia classified by ADA criteria, and A1c findings were evaluated according to International Expert Committee (IEC, prediabetes 6.0-6.4%, diabetes [underline][gt][/underline]6.5%), ADA (5.7-6.4% and [underline][gt][/underline]6.5%), and new VA/Dept of Defense (VA, 5.7-6.9% and [underline][gt][/underline]7.0%) guidelines.[br]The 680 subjects were 96% male, 73% black, and 26% white, with average age 58 yr and BMI 30. By OGTT, 11% had diabetes (DIAB) and 41% prediabetes (PRE). In patients with DIAB by OGTT, A1c classification was incorrect in 76% by IEC criteria, 76% by ADA, and 87% by VA. With PRE by OGTT, A1c classification was incorrect in 66% by IEC, 41% by ADA, and 36% by VA. With NL by OGTT, A1c classification was incorrect in 21% by IEC, 56% ADA, and 57% VA. Weighted misclassification with A1c testing (DIAB*2 + PRE*1 + NL*0.5) averaged 56% with IEC, 54% ADA, and 54% VA. [underline]Conclusions:[/underline] Many veterans targeted by ADA guidelines have unrecognized dysglycemia, showing the need for screening. However, screening such patients by measuring A1c would Continue reading >>

Va/dod Clinical Practice Guideline For The Management Of Dyslipidemia For Cardiovascular Risk Reduction.

Va/dod Clinical Practice Guideline For The Management Of Dyslipidemia For Cardiovascular Risk Reduction.

Type of Evidence Supporting the Recommendations The type of evidence supporting the recommendations is not specifically stated. Table A-2 in the original guideline documents indicates the number and type of studies that addressed each of the key questions. The evidence base consists primarily of systematic reviews and randomized controlled trials. This Clinical Practice Guideline (CPG) and algorithm are designed to be adapted by individual facilities in consideration of local needs and resources. The algorithm serves as a guide that providers can use to determine best interventions and timing of care for their patients in order to optimize quality of care and clinical outcomes. Although this CPG represents clinical practice on the date of its publication, medical practice is evolving and this evolution requires continuous updating based on published information. This CPG can assist in identifying priority areas for research and optimal allocation of resources. Benefits/Harms of Implementing the Guideline Recommendations Efficient and effective assessment of the patient's condition Optimizing the use of therapy to reduce symptoms and enhance functionality Minimizing preventable complications and morbidity of dyslipidemia Use of personalized, proactive, patient-driven care Potential adverse effects and drug interactions for statin and non-statin pharmacologic agents are provided in Table D-1 in the original guideline document. Rating Scheme for the Strength of the Recommendations The relative strength of the recommendation is based on a binary scale, "Strong" or "Weak." A strong recommendation indicates that the Work Group is highly confident that desirable outcomes outweigh undesirable outcomes. If the Work Group is less confident of the balance between desirable and un Continue reading >>

Synopsis Of The 2017 U.s. Department Of Veterans Affairs/u.s. Department Of Defense Clinical Practice Guideline: Management Of Type 2 Diabetes Mellitus.

Synopsis Of The 2017 U.s. Department Of Veterans Affairs/u.s. Department Of Defense Clinical Practice Guideline: Management Of Type 2 Diabetes Mellitus.

From VA Boston Healthcare System, West Roxbury, Massachusetts; San Antonio Military Medical Center, Fort Sam Houston, Texas; Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina; San Diego Internal Medicine, San Diego, California; and Veterans Affairs Central Office, Office of Specialty Care Services, Washington, DC. In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus. The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. This synopsis summarizes key features of the guideline in 7 areas: patient-centered care and shared decision making, glycemic biomarkers, hemoglobin A1c target ranges, individualized treatment plans, outpatient pharmacologic treatment, glucose targets for critically ill patients, and treatment of hospitalized patients. Continue reading >>

New Guidelines Released For Type 2 Diabetes

New Guidelines Released For Type 2 Diabetes

New Guidelines Released for Type 2 Diabetes New Guidelines Released for Type 2 Diabetes (HealthDay News) -- Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online in the Annals of Internal Medicine. Paul R. Conlin, MD, from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint US Department of Veterans Affairs (VA) and US Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes mellitus. The authors provided updates on management within seven areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of hemoglobin A1c (HbA1c), individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice," the authors write. Oral Hypoglycemic Continue reading >>

Va/dod Diabetes Guidelines Vary Significantly From Other Groups

Va/dod Diabetes Guidelines Vary Significantly From Other Groups

VA/DoD Diabetes Guidelines Vary Significantly From Other Groups By Brenda L. Mooney, MDalert.com Contributor Save to PDF December 20, 2017 By By Brenda L. Mooney, MDalert.com Contributor New clinical guidelines on diabetes were jointly published earlier this year by the Department of Veterans Affairs (VA) and the Department of Defense (DoD) and may be of great interest to health care providers outside of federal medicine. One reason is that the VAs Choice program is pushing an increasing amount of veteran care into the community, with the agency reporting it had authorized more than 15 million such appointments in the first six months of this year. Another is that the VA/DoD diabetes guidelines , which were published in the Annals of Internal Medicine, differ in some significant ways from those issued by the American Diabetes Association (ADA), the American Geriatric Society (AGS) and the American Association of Clinical Endocrinologists (AACE). Veteran with diabetes. (Source: U.S. Dept. of Veterans Affairs ) The VA/DoD clinical practice guidelines (CPG) address diabetes management in seven areas: patient-centered care and shared decision-making, glycemic biomarkers, target ranges of HbA1c, individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Among the key recommendations are that patients should be offered individualized diabetes self-management education, individualized glycemic management plans, and individualized target ranges for HbA1c. It makes few explicit recommendations on pharmacologic treatment, however, with one being the use of insulin for patients with significant symptoms, ketosis, type 1 diabetes or severe hyperglycemia. Gener Continue reading >>

The Va's Personal Approach To Diabetes | Defense Media Network

The Va's Personal Approach To Diabetes | Defense Media Network

Labels: Military Medicine , Veterans Affairs While the population of U.S. veterans is a fairly representative slice of the American population, there are some differences, particularly among veterans enrolled to receive health care in the Veterans Health Administration (VHA). One of the most conspicuous differences is in the prevalence of diabetes, a chronic disease in which the body cannot produce or properly use the metabolic hormone insulin, resulting in elevated blood glucose. According to the U.S. Centers for Disease Control and Prevention, an estimated 30.2 million Americans, 9.4 percent of the population, have diabetes. About 9.9 million, or 40 percent, of persons with diabetes are 65 or older. Of the more than 5.6 million veterans who received care in the VHA through mid-2017, by contrast, more than 1.5 million about 27 percent have diabetes. Among these veterans, about 70 percent are aged 65 or older. Older adults with diabetes often have significant co-existing conditions or complications, a lack of social support, or food insecurity, circumstances that increase the likelihood of hypoglycemic reactions episodes of low blood sugar or insulin shock. While many Americans with diabetes a little over half are estimated to be otherwise healthy, this number is somewhat lower among veterans; about 40 to 45 percent of veterans with diabetes have no serious coexisting disease. The most common form of the disease, type 2 diabetes mellitus, is the leading cause of blindness, end-stage kidney disease, and amputation for VA patients, and often leads to stroke, nerve damage, and contributes to cardiovascular disease the leading cause of death among all persons with diabetes. After a generation of World War II veterans suffered through an era in which the benefit of blood gl Continue reading >>

Va/dod: Recommendations For The Management Of Type 2 Diabetes Mellitus

Va/dod: Recommendations For The Management Of Type 2 Diabetes Mellitus

VA/DoD: Recommendations for the Management of Type 2 Diabetes Mellitus Individualized management should include education, glycemic management plans, target HbA1c, state the guidelines HealthDay News Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online October 23 in the Annals of Internal Medicine. Paul R. Conlin, MD, from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint U.S. Department of Veterans Affairs (VA) and US Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes mellitus. FDA Committee Supports Semaglutide Approval for Type 2 Diabetes The authors provided updates on management within 7 areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of hemoglobin A1c (HbA1c), individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision maki Continue reading >>

Department Of Veterans Affairs/department Of Defense (va/dod) Clinical Practice Guideline For The Management Of Diabetes Mellitus (dm) In Primary Care. Guideline Summary

Department Of Veterans Affairs/department Of Defense (va/dod) Clinical Practice Guideline For The Management Of Diabetes Mellitus (dm) In Primary Care. Guideline Summary

Department of Veterans Affairs/Department of Defense (VA/DoD) Clinical Practice Guideline for the Management of Diabetes Mellitus (DM) in Primary Care. Guideline Summary Department of Veterans Affairs/Department of Defense (VA/DoD) Clinical Practice Guideline for the Management of Diabetes Mellitus (DM) in Primary Care. Guideline Summary This 40-page guideline summary is derived from the evidence-based clinical practice guideline, Management of Diabetes Mellitus, developed by the Department of Veterans Affairs and Department of Defense (VA/DoD). It is intended to: Promote evidence-based management of individuals with diabetes Identify the critical decision points in management of patients with diabetes mellitus, such as glycemic control, evaluation of the eyes and feet, and comorbid conditions (e.g., hypertension, hyperlipidemia, and renal disease) Allow flexibility so that local policies or proceduressuch as those regarding referrals to or consultation with diabetes teams, ophthalmology, optometry, podiatry, nephrology, and endocrinologycan be accommodated Decrease the development of complications Improve local management of patients with diabetes and thereby improve patient outcomes This guideline summary addresses the following topics: Recommendations with the highest evidence Table 4: Low density lipoprotein cholesterol thresholds Table 1: Determination of target hemoglobin A1c (HbA1c) level Table 5: Comparison of insulin preparations Table 7: Guidelines for insulin adjustment Table 2: Factors that transiently interfere with urinary screening for albuminuria Table 3: Definition of chronic kidney disease (CKD) Continue reading >>

New Clinical Practice Guideline For Management Of T2dm

New Clinical Practice Guideline For Management Of T2dm

New Clinical Practice Guideline for Management of T2DM WEDNESDAY, Oct. 25, 2017 (HealthDay News) -- Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online Oct. 23 in the Annals of Internal Medicine. Paul R. Conlin, M.D., from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes mellitus. The authors provided updates on management within seven areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of hemoglobin A1c (HbA1c), individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients, and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice," the authors write. Continue reading >>

Medical Xpress: New Clinical Practice Guideline For Management Of T2dm

Medical Xpress: New Clinical Practice Guideline For Management Of T2dm

New clinical practice guideline for management of T2DM (HealthDay)Management of type 2 diabetes should include shared decision making, and patients should be offered individualized diabetes self-management education and glycemic management plans, according to a summary of a clinical practice guideline published online Oct. 23 in the Annals of Internal Medicine. Paul R. Conlin, M.D., from the VA Boston Healthcare System in West Roxbury, Massachusetts, and colleagues convened a joint U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Evidence-Based Practice Work Group to develop a guideline for management of type 2 diabetes mellitus . The authors provided updates on management within seven areas: patient-centered care and shared decision making, glycemic biomarkers, target ranges of hemoglobin A1c (HbA1c), individualized treatment plans, pharmacologic treatment in the outpatient setting, glucose targets for critically ill patients , and treatment for patients in the hospital. Patients should be offered individualized diabetes self-management education, as well as individualized glycemic management plans and target ranges for HbA1c. "In summary, the VA/DoD CPG [clinical practice guideline] attempts to convey to clinicians, policymakers, and patients the rationale for personalizing treatment on the basis of results from major trials, limitations of the HbA1c test, and evaluation of patient risk for adverse drug events. Conveying complex information in an understandable manner to individual patients and families through a formal process of shared decision making is thus foundational to setting and revising goals that are meaningful, safe, and achievable in everyday clinical practice," the authors write. Continue reading >>

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Treating a Million Diabetes Patients, VA Stays at Cutting Edge With responsibility for treating diabetes in more than a million veterans in its primary-care population, VA is at the leading edge of care for the metabolic disease. For example, an article this spring in the Annals of Internal Medicine focused on an ongoing debate in medical circles: Whether a one-size-fits-all target level for Hemoglobin A1c in diabetes is the best approach, or whether an individualized approach is more appropriate. The authors supported the latter approach one that VA has long endorsed. Dr. Leonard Pogach, VA Diabetes Program Director (left), reviews Clinical Practice Guideline Criteria with staff. Photo from VA website. The VA/DoD Clinical Practice Guidelines for Diabetes have for more than 10 years included stratified targets based on life expectancy and co-comorbidities, wrote a group of authors responding to the study on behalf of the VA/DoD Diabetes Practice Guidelines Working Group. Moreover, all of the trials referred to in their article were utilized in updating the guidelines which were released in August, 2010. Unlike the more specific glycemic targets recommended by the authors in the Annals article, however, the VA/DoD Diabetes Practice Guidelines Working Group, the response noted, Recommends target ranges rather than single targets from <7%, 7-8%, and 8-9%. (Please see the table on final page.) What I can tell you is that, over time, many of the VA-DoD recommendations that seemed controversial at the time because they did not agree with professional society guidelines now seem to be good science that is, our experts were properly cautious, said Leonard M. Pogach, MD, MBA, the Veterans Health Administration national program director for endocrinology and diabetes, Office of Continue reading >>

Adding Glucose-lowering Agents Delays Insulin Initiation And Prolongs Hyperglycemia

Adding Glucose-lowering Agents Delays Insulin Initiation And Prolongs Hyperglycemia

Marissa Escobar Quinones, PharmD, CDE; Margaret Youngmi Pio, PharmD, BCPS, CDE; Diem Hong Chow, PharmD, CDE; Elizabeth Moss, PharmD, CDE, BCACP; Jeffrey Lynn Hulstein, PharmD, CDE; Steven Micheal Bo Adding Glucose-Lowering Agents Delays Insulin Initiation and Prolongs Hyperglycemia Courtney Hugie, PharmD, BCPS; Nancee V. Waterbury, PharmD, BCACP; Bruce Alexander, PharmD; Robert F. Shaw, PharmD, MPH, BCPS, BCNSP; and Jason A. Egge, PharmD, MS, BCPS The American Journal of Managed Care > April 2016 Published on: April 08, 2016 Adding Glucose-Lowering Agents Delays Insulin Initiation and Prolongs Hyperglycemia Courtney Hugie, PharmD, BCPS; Nancee V. Waterbury, PharmD, BCACP; Bruce Alexander, PharmD; Robert F. Shaw, PharmD, MPH, BCPS, BCNSP; and Jason A. Egge, PharmD, MS, BCPS A review of national Veterans Health Administration data has identified how the number of glucose-lowering agents used prior to insulin initiation impacts glycemic control. Objectives: Nine classes of glucose-lowering agents (GLAs) are available for patients with type 2 diabetes prior to starting insulin. This studys aim was to determine if the number of GLAs is associated with a difference in glycated hemoglobin (A1C) at insulin initiation in the US Department of Veterans Affairs Health Care System (VAHCS). Study Design: Retrospective cohort study. Methods: A retrospective cohort with national Veterans Health Administration data was created. Veterans with type 2 diabetes and first insulin prescription filled in the VAHCS between January 1, 2009, and August 28, 2013, were identified. Included veterans refilled insulin within the first year, had an A1C >7% (53 mmol/mol) at least 60 days prior to insulin initiation, and received a GLA within 6 months prior to insulin. Veterans were grouped into 4 cohor Continue reading >>

Integrating Diabetes Guidelines Into A Telehealth Screening Tool

Integrating Diabetes Guidelines Into A Telehealth Screening Tool

Integrating Diabetes Guidelines into a Telehealth Screening Tool by Kelly Gervera, DNP, RN, and Barbara Ann Graves, PhD, RN Diabetes is the seventh leading cause of death in the United States and contributes to long-term complications that are costly to healthcare systems. Twenty-five percent of all veterans in the Veterans Health Administration (VHA) have diabetes. The purpose of this article is to describe the development and implementation of a quality improvement project to embed an evidence-based diabetes screening tool, based on Veterans Affairs/Department of Defense diabetes clinical practice guidelines, into the VHA electronic medical record. The objectives of the screening tool were threefold: to promote evidence-based care, to standardize care coordination, and to promote self-management and proper utilization of resources. Record reviews were conducted to evaluate the effectiveness of the screening tool. Results showed an 88 percent increase in the assessment of annual exams and/or labs, a 16.5 percent increase in disease management assessment and offering of services, and a 50 percent increase in goal-setting activity. Key words: diabetes, guidelines, telehealth, screening tool Diabetes is the seventh leading cause of death in the United States and contributes to long-term complications that are costly to the healthcare system. 1 The total estimated healthcare cost related to diabetes care for the general population in the United States in 2013 was $245 billion. 2 Diabetes is the leading cause of blindness in adults age 20 to 74 years, and diabetic retinopathy is linked to 12,000 to 24,000 new cases of blindness each year. 3 In 2008, an estimated 202,290 diabetic patients had dialysis or kidney transplants. 4 Also, 60 percent of all nontrauma lower extremit Continue reading >>

Synopsis Of The 2017 U.s. Department Of Veterans Affairs/ U.s. Department Of Defense Clinical Practice Guideline: Management Of Type 2 Diabetes Mellitus

Synopsis Of The 2017 U.s. Department Of Veterans Affairs/ U.s. Department Of Defense Clinical Practice Guideline: Management Of Type 2 Diabetes Mellitus

N2 - Description: In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus. Methods: The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. Recommendations: This synopsis summarizes key features of the guideline in 7 areas: patient-centered care and shared decision making, glycemic biomarkers, hemoglobin A1c target ranges, individualized treatment plans, outpatient pharmacologic treatment, glucose targets for critically ill patients, and treatment of hospitalized patients. AB - Description: In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus. Methods: The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016 Continue reading >>

For Type 2 Diabetes, Less Intensive Hba1c Goals Promise Less Harm

For Type 2 Diabetes, Less Intensive Hba1c Goals Promise Less Harm

For Professionals Research Updates Diabetes complications For Type 2 Diabetes, Less Intensive HbA1c Goals Promise Less Harm Need for intensive drug treatment to reduce hemoglobin A1C targets called into question by the American College of Physicians but defended by the leading endocrine-related organizations, placing clinicians in the middle of debate over T2D treatment. Nearly 1 in 10 Americansmore than 29 million personshave type 2 diabetes mellitus (T2D), which is a leading cause of morbidity and mortality in the US.1 Treatment has been focused on lowering blood glucose levels, specifically hemoglobin A1c, to a specific target level in order to minimize risks for cardiovascular, cerebrovascular, neurologic, ophthalmologic, and renal complications (among others). A growing body of evidence now indicates that reducing blood glucose levels, while beneficial in lowering risk of complications, is also associated with potential harms, additional patient burden, and potentially higher costs fornonpregnant adults.2 This update, Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: A Guidance Statement Update from the American College of Physicians, focuses solely on the benefits and harms of targeting lower versus higher HbA1c levels, and does not address specific medications or other populations with T2D.2 Intensive Treatment for Type 2 Diabetes Should be Replaced with Individualized Care The evidence-based analysis determined that the harms associated with intensive treatment with drugs to targets of < 7% could be greater than the benefits, Jack Ende, MD, President of ACP and the Schaeffer Professor of Medicine at the Perelman School of Medicine at The University of Pennsylvania, in Philadelphia, told Continue reading >>

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