Ada Diabetes Management Guidelines A1c Diagnosis | Ndei
Criteria for Diabetes Diagnosis: 4 options Fasting is defined as no caloric intake for 8 hours 2-hr PG 200 mg/dL (11.1 mmol/L) during OGTT (75-g)* Using a glucose load containing the equivalent of 75g anhydrous glucose dissolved in water Performed in a lab using NGSP-certified method and standardized to DCCT assay In individuals with symptoms of hyperglycemia or hyperglycemic crisis No clear clinical diagnosis? Immediately repeat the same test using a new blood sample. Same test with same or similar results? Diagnosis confirmed. Different tests above diagnostic threshold? Diagnosis confirmed. Discordant results from two separate tests? Repeat the test with a result above diagnostic cut-point. Conditions associated with insulin resistance *African-American, Latino, Native American, Asian American, Pacific Islander Severe obesity, acanthosis nigricans, polycystic ovarian syndrome Screening Children for Type 2 Diabetes and Prediabetes Consider screening for type 2 diabetes and prediabetes for all children who are overweight* and have two or more of the following risk factors: Family history of type 2 diabetes in a first- or second-degree relative Native American, African American, Latino, Asian American, or Pacific Islander descent Signs of insulin resistance or conditions associated with insulin resistance Maternal history of diabetes or GDM during the childs gestation Test every 3 years using A1C beginning at age 10 or onset of puberty *BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% ideal weight Acanthosis nigricans, hypertension, dyslipidemia, polycystic ovarian syndrome, or small-for-gestational-age birth weight Screening for Gestational Diabetes (GDM) Test for undiagnosed type 2 at first prenatal visit using standard diagnos Continue reading >>
New Guidelines Urge A1c Test For Diabetes Diagnosis
Yahoo!-ABC News Network | 2018 ABC News Internet Ventures. All rights reserved. New Guidelines Urge A1C Test for Diabetes Diagnosis TUESDAY, Dec. 29 (HealthDay News) -- In its latest set of clinical guidelines, the American Diabetes Association is promoting a more prominent role for the hemoglobin A1C blood test in the diagnosis of type 2 diabetes and prediabetes. Long used in the management of diabetes, the A1C blood test measures average blood sugar levels for the previous two to three months. The new guidelines call for the diagnosis of type 2 diabetes at A1C levels above 6.5 percent, and prediabetes if the A1C levels are between 5.7 and 6.4 percent. "We've added another test that can make it easier to find out if you have diabetes," said Dr. Richard Bergenstal, president-elect of medicine and science for the American Diabetes Association (ADA). The new guidelines will be published in the January issue of Diabetes Care. Bergenstal said the A1C isn't necessarily superior to other methods used to detect type 2 diabetes and prediabetes, such as fasting blood sugar tests and the oral glucose tolerance test, but it is easier and more convenient for people because you don't have to fast before an A1C test. In the past, the A1C wasn't recommended for use in the diagnosis of diabetes because the test wasn't standardized from lab to lab, according to the ADA. That means a reading of 6.5 percent at one lab could have been 6.3 percent at another. Now, the test is highly standardized, according to the ADA, making it a useful tool for detecting diabetes and prediabetes without the need for fasting. "I think we may diagnose more people because the A1C is used a lot more now because of its convenience," Bergenstal said. The A1C measures the percentage of hemoglobin (the main compo Continue reading >>
A New Set Of Type 2 Care Guidelines, And Where They Fall Short
A New Set of Type 2 Care Guidelines, and Where They Fall Short Recommendations from the American College of Physicians focus on relaxing A1c goals without considering up-to-date CGM and therapy options A new set of recommendations could have substantial and potentially counterproductive effects on type 2 diabetes care. The guidelines from the American College of Physicians (ACP) , an influential organization with over 150,000 members, call for the majority of people with diabetes and their providers to raise their A1c goals, in most cases to 7-8%. This contradicts the recommendations of other leading professional organizations, which suggest an A1c target of at least <7%. The ACP guidelines do not address many of the newer, highly-effective therapies and technologies available today, and they overlook the fact that A1c can be an insufficient and even potentially misleading measure. Given that well over 20 million people in the US have diagnosed diabetes (an estimated 7.2 million more have diabetes but dont know it) including 1.4 million people diagnosed in 2015 according to new CDC data and given that over 30% of people with diabetes have A1c levels over 9%, these new guidelines may be unproductive for many. Read on to learn more, or click to jump directly to a section: What do the new ACP guidelines recommend? The ACP offered four Guidance Statements for type 2 diabetes care. These statements boil down to: A1c targets for people with type 2 diabetes should be personalized based on: the pros and cons of therapy options including side-effects-versus-benefits consideration as well as financial or emotional burdens. For most people with type 2 diabetes, an A1c target of 7-8% will probably be appropriate. For people with type 2 diabetes who have an A1c of 6.5% or lower, cl Continue reading >>
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New Type 2 Diabetes Guideline Recommends More Moderate Hba1c Target
New type 2 diabetes guideline recommends more moderate HbA1c target New type 2 diabetes guideline recommends more moderate HbA1c target The American College of Physicians (ACP) has developed guidance recommendation statements for clinicians in selecting targets for the pharmacologic treatment of type 2 diabetes , as published in the Annals of Internal Medicine. The Clinical Guidelines Committee of the ACP, led by Amir Qaseem, MD, PhD, MHA, analyzed national guidelines that addressed hemoglobin A1c (HbA1c) targets for treating type 2 diabetes in nonpregnant outpatient adults. Based on its review, the ACP recommends that patients with type 2 diabetes should be treated to achieve an A1C between 7% and 8%, rather than 6.5% to 7%. ACP's analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7% or less compared to targets of about 8% did not reduce deaths or macrovascular complications such as heart attack or stroke but did result in substantial harms, stated Jack Ende, MD, president of the ACP. The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7% and 8% will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs. A summary of the guidelines is as follows: Clinicians should personalize goals for glycemic control in patients with type 2 diabetes on the basis of a discussion of benefits and harms of pharmacotherapy, patients' preferences, patients' general health and life expectancy, treatment burden, and costs of care. Clinicians should aim to achieve an HbA1c level between 7% and 8% in most patients with type 2 diabetes. Clinicians should consider deintensifying pharmacologic therapy in patients with type 2 diabetes who achieve HbA1c levels less than 6.5% Continue reading >>
New Diabetes Guidelines Already Outdated?
New Diabetes Guidelines Already Outdated? Today I am going to talk about the American College of Physicians (ACP) guidelines for glycated hemoglobin (A1c) treatment targets in patients with type 2 diabetes.[ 1 ] Before I continue, I should tell you that I disagree with what they say. All of the major organizations that involve endocrinologists in this country also disagree with what they have to say . But I am not just going to be argumentative. I am going to discuss ways in which I believe they are correct and ways in which I believe they are incorrect. The first point in the guideline is that you should individualize targets, and I can't agree more. Every patient deserves an individualized target. The next three recommendations, however, go way off the rails. [Editor's Note: These recommend setting most A1c targets between 7% and 8%, scaling back treatment when A1c drops below 6.5%, and avoiding A1c targets altogether in elderly and chronically ill patients where harms might outweigh benefits.][ 1 ] I say this because the ACP used six other guidelines to create their own, and I believe that they looked at studies incorrectly and drew conclusions that are not germane to the way we treat patients with type 2 diabetes today. To set the record straight, they are very concerned about hypoglycemia risk and weight gain. I am also very concerned about hypoglycemia and weight gain. And in all of the older studies, these were major risks. But we now have drugs that do not cause hypoglycemia and weight gain. We actually have drugs for the treatment of type 2 diabetes that reduce both cardiovascular risk and progression of nephropathy. So, I think the way the world looks for the treatment of type 2 diabetes now is quite different from the world when the studies they are quoting Continue reading >>
Controversial New A1c Recommendations For Diabetes: What To Know | Everyday Health
RELATED: How Brooklyn Politician Eric Adams Lowered His A1C and Reversed Diabetes Through Diet Changes A Closer Look at the Doctors Proposed A1C Guidelines To make the new recommendations, study authors analyzed past studies and guidelines issued by other organizations from around the world. Beyond making the general recommendation for a new A1C target, the group proposed the following three guidelines: Ease up on diabetes treatment for any patient with an A1C of 6.5 or lower, to avoid his or her blood sugar levels from dipping further. Individualize management goals based on factors like life expectancy, cost of care, and medication risk. Do not set a target A1C level in people who have a life expectancy of less than 10 years due to advanced age (80 years old or older), have certain chronic conditions, or are living in a nursing home. Six coauthors of the report assessed each guideline using a tool that evaluates research materials based on six criteria, including clarity of presentation and a study's scope and purpose. While the ACP did not return repeated requests for comment before publication of this story, Jack Ende, MD, president of the ACP who is based in Philadelphia, said in a news release that avoiding treatment in people with an A1C below 6.5 will reduce unnecessary medication harms, burdens, and costs without negatively impacting the risk of death, heart attacks, strokes, kidney failure, amputations, visual impairment, or painful neuropathy, referencing macrovascular complications. Type 2 diabetes is a widespread problem and is linked to the complications Dr. Ende mentions in the release. There are more than 30 million people in the United States who have diabetes, with 90 to 95 percent of them having type 2 diabetes, according to the Centers for Disease C Continue reading >>
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The American College Of Physicians Recommends A1c Levels Between 7 And 8 Percent : Shots - Health News : Npr
A major medical association today suggested that doctors who treat people with Type 2 diabetes can set less aggressive blood sugar targets. But medical groups that specialize in diabetes sharply disagree. Half a dozen medical groups have looked carefully at the best treatment guidelines for the 29 million Americans who have Type 2 diabetes and have come up with somewhat differing guidelines. The American College of Physicians has reviewed those guidelines to provide its own recommendations , published in the Annals of Internal Medicine. It has decided that less stringent goals are appropriate for the key blood sugar test, called the A1C. "There are harms associated with overzealous treatment or inappropriate treatment focused on A1C targets," says Dr. Jack Ende , president of the ACP. "And for that reason, this is not the kind of situation where the college could just sit back and ignore things." The ACP, which represents internists, recommends that doctors aim for an A1C in the range of 7 to 8 percent, not the lower levels that other groups recommend. For people who have already achieved a lower level, "consider de-intensifying treatment," Ende says. "That is, reducing one of the medications, stopping a medication, just allow the A1C to be between 7 and 8." This Chef Lost 50 Pounds And Reversed Prediabetes With A Digital Program Some studies have shown that people who have aggressively pushed to lower their blood sugar are at somewhat higher risk of premature death. People also suffer from low blood sugar as a result of aggressive treatment. That was the case for Valerie Pennington, a special-needs teacher who lives in Odessa, Mo. She was diagnosed in her mid-40s and put on an aggressive treatment regime. "The nurse at school because I was going low so much made me ge Continue reading >>
Could New Diabetes A1c Guidelines Do More Harm Than Good?
Could New Diabetes A1C Guidelines Do More Harm Than Good? Written by Mike Hoskins on March 13, 2018 The American College of Physicians (ACP) has published new care guidelines suggesting higher blood sugar targets for people with type 2 diabetes. But many fear they may be doing harm than good with this change, that could potentially lead to patients developing more long-term complications and PWDs (people with diabetes) facing increased barriers to accessing to the supplies and medications we need. Not good. Published March 6 in the Annals of Internal Medicine , these new guidelines call for A1C targets of 7-8% for most T2 PWDs, noting that lower A1C goals of 6.5% to 7% as recommended by the big diabetes orgs are too strict. While the new guidelines do recommend "personalization of glycemic goals" depending on patients' individual circumstances, they clearly call for "deintensifying" therapy across the board. The ACP cites studies showing evidence that encouraging T2s to check blood sugar more often and take more medications has not been beneficial. "The evidence shows that for most people with type 2 diabetes, achieving an A1C between 7-8% will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs, ACP President Dr. Jack Ende said in a press release . Not everyone agrees. In fact, this is causing a firestorm among the diabetes authorities, who worry that these new guidelines, while specific to T2, could have negative implications for all PWDs: downgrading care and providing a basis for insurers to further restrict access to testing supplies, needed medicines and of course CGMs (continuous glucose monitors). The ACP guidelines are aimed at primary care physicians, who remain the main source of care for millions of T2Ds in this Continue reading >>
New (more Moderate) Guidelines For Hba1c Levels
New (More Moderate) Guidelines for HbA1c Levels The American College of Physicians (ACP) has issued new guidelines regarding the target blood sugar control levels for people with type 2 diabetes who are not pregnant, and the recommendations aim for a more moderate target.1 The hemoglobin A1C (HbA1c) test is frequently used in people with type 2 diabetes as a measure of how their blood sugar is controlled. HbA1c averages a persons blood sugar levels from the previous 2-3 months, and it is often used during initial diagnosis as well, with a score of 6.5% indicating diabetes. Traditionally, people with type 2 diabetes have been advised to keep their HbA1c levels below 7% (basically, at 6.5%). However, new research has prompted experts to issue new guidelines that the target HbA1c level for people with type 2 diabetes who are not pregnant should be between 7% and 8%.1,2 Originally, it was believed that keeping HbA1c levels below 7% would reduce the long-term risk of microvascular complications (those related to the smallest blood vessels), such as diabetic retinopathy (changes to eyesight or even blindness), kidney disease , and neuropathy (nerve damage that can cause numbness or pain).2,3 In creating the new guidelines, the ACP reviewed several research studies and found that for most people with type 2 diabetes, aiming for an HbA1c level between 7% and 8% best balances the long-term benefits with the potential risks of medications , including low blood sugar and health care costs.1,2 The latest research indicates that a slightly higher A1c level does not negatively impact patients and does not increase the risk of death, heart attacks, stroke, kidney failure, visual impairment , amputations, or neuropathy, according to Dr. Jack Ende, the president of the ACP. While medic Continue reading >>
Setting Appropriate A1c Goals For Patients With Type 2 Diabetes
Condition Center Home > Clinical Essentials Setting Appropriate A1C Goals for Patients With Type 2 Diabetes Are the ADA's A1C target recommendations for type 2 diabetes patients too conservative? Or is the AACE/ACE Consensus Statement's approach too aggressive? Reviewed by Clifton Jackness, MD, Attending Physician in Endocrinology, Lenox Hill Hospital and the Mount Sinai Medical Center, New York, NY Assessment of glycemic control in patients with type 2 diabetes can be achieved through patient self-monitoring of blood glucose (SMBG) and A1C determinations.1,2 The American Diabetes Association (ADA) recommends regular A1C testing to evaluate the effectiveness of current management strategies, but the target A1C goal can vary depending on the individual patient profile as well as the set of professional consensus recommendationsand associated management philosophyto which the treating clinician adheres. According to the ADA, the generally accepted standard A1C goal for adult patients with type 2 diabetes is 7.0%.1,2 Driving A1C below this level has been shown to reduce microvascular complications. In addition, if achieved quickly after a diabetes diagnosis, this A1C goal has been associated with a long-term reduction in macrovascular disease as well.1,2 According to ADA guidelines, the standard A1C goal for adults with T2DM is 7.0%, but this can vary depending on individual patient profiles. The AACE/ACE recommendations are more aggressive, with a target A1C of ?6.5% to minimize risk of diabetes-related complications. Until large clinical trials utilizing newer therapies are done to evaluate the risks and benefits of intensive therapy, it is likely that the ADA and AACE/ACE recommendations will continue to differ. The ADA suggests that physicians may lower the A1C target Continue reading >>
Type 2 Diabetes: New Guidelines Lower Blood Sugar Control Levels
Type 2 diabetes: New guidelines lower blood sugar control levels The American College of Physicians have now published their new guidelines regarding the desired blood sugar control levels for people with type 2 diabetes. The recommendations aim to change current therapeutic practices, and doctors should aim for a moderate level of blood sugar when treating their patients. Blood sugar control levels should be moderate for people living with type 2 diabetes, according to new guidelines. According to the most recent estimates, almost 30 million people in the United States have type 2 diabetes , which amounts to over 9 percent of the entire U.S. population. Once diagnosed with type 2 diabetes, patients are often advised to take what is known as a glycated hemoglobin (HbA1c) test in order to keep blood sugar levels under control. The test averages a person's blood sugar levels over the past 2 or 3 months, with an HbA1c score of 6.5 percent indicating diabetes . But some studies have pointed out that the HbA1c test may currently be overused in the U.S., and they have suggested that such over-testing may lead to over-treating patients with hypoglycemic drugs. These drugs often have a range of side effects, such as gastrointestinal problems, excessively low blood sugar, weight gain, and even congestive heart failure . Additionally, as some researchers have pointed out, "Excessive testing contributes to the growing problem of waste in healthcare and increased patient burden in diabetes management." In this context, the American College of Physicians (ACP) set out to examine the existing guidelines from several organizations and the evidence available in an effort to help physicians make better, more informed decisions about treating people with type 2 diabetes. Their guideline Continue reading >>
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Acp Guidance Statement On Hba | Annals Of Internal Medicine | American College Of Physicians
Author, Article, and Disclosure Information This article was published at Annals.org on 6 March 2018. * This paper, authored by Amir Qaseem, MD, PhD, MHA; Timothy J. Wilt, MD, MPH; Devan Kansagara, MD, MCR; Carrie Horwitch, MD, MPH; Michael J. Barry, MD; and Mary Ann Forciea, MD, was developed for the Clinical Guidelines Committee of the American College of Physicians. Individuals who served on the Clinical Guidelines Committee from initiation of the project until its approval were Mary Ann Forciea, MD (Chair); Nick Fitterman, MD; Kate Balzer, MSW; Michael J. Barry, MD; Cynthia Boyd, MD, MPH; Carrie Horwitch, MD, MPH; Linda L. Humphrey, MD, MPH; Alfonso Iorio, MD, PhD; Devan Kansagara, MD, MCR; Jennifer Lin, MD, MCR; Scott Manaker, MD, PhD; Michael Maroto, JD, MBA; Robert McLean, MD; Reem Mustafa, MD, PhD, MPH; Janice Tufte; Sandeep Vijan, MD, MS; and Timothy J. Wilt, MD, MPH. Approved by the ACP Board of Regents on 26 March 2017. Author (participated in discussion and voting). Nonauthor contributor (participated in discussion but excluded from voting). American College of Physicians, Philadelphia, Pennsylvania (A.Q.) Minneapolis Veterans Affairs Medical Center, Minneapolis, Minnesota (T.J.W.) Oregon Health & Science University and Veterans Affairs Medical Center, Portland, Oregon (D.K.) Virginia Mason Medical Center, Seattle, Washington (C.H.) Massachusetts General Hospital, Boston, Massachusetts (M.J.B.) University of Pennsylvania Health System, Philadelphia, Pennsylvania (M.A.F.) Note: Guidance statements are guides only and may not apply to all patients and all clinical situations. Thus, they are not intended to override clinicians' judgment. All ACP guidance statements are considered automatically withdrawn or invalid 5 years after publication, or once an update h 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. 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 Cardiologys recently updated blood pressure guidelines . The ADAs 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 Continue reading >>
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Diabetes Guidelines Relax Blood Sugar Management
A major medical association recommends relaxing blood sugar management by Garrett Schaffel, March 9, 2018|Comments: 0 Diabetes is the seventh leading cause of death in the United States. The American College of Physicians (ACP) on Tuesday published new recommendations for blood sugar management in those with type 2 diabetes . The guidelines call for relaxing target glucose levels and differ from those established by the American Diabetes Association (ADA) and other medical organizations. As a result, the news ignited plenty of back-and-forth on the subject. The standard recommendation has been to shoot for an A1C a blood test measuring blood sugar levels of less than 7 percent. This recommendation is supported by many medical associations, including the ADA and the American Association of Clinical Endocrinologists (AACE). Above 7 percent, their experts say, patients have undue risk of life-threatening health problems associated with high blood sugar. One of those problems, of course, is diabetes, the seventh leading cause of death in the United States. But the ACPs new target, published in theAnnals of Internal Medicine,is for between 7 and 8 percent. Why is it controversial? The ACP recommendation is higher than the standard recommendation for diabetic patients and, according to a recent ADA press release, "has the potential to do more harm than good for many patients for whom lower blood glucose targets may be more appropriate."For people ages 80 and older and those with chronic medical issues , however, the recommendation would not apply. The ADA publicly rejected the ACPs guidance, as did the AACE. Its been clear over the years that decreasing the A1C decreases common diabetes complications, including kidney, eye and nerve complications, says AACE President Jonatha Continue reading >>
Clinical Use
Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. From the Executive Summary of the 2014 American Diabetes Association Clinical Practice Recommendations (Diabetes Care 2014;37,suppl.1:S5-13) Consider A1C targets as close to non-diabetic levels (< 6.5 percent) as possible without significant hypoglycemia in people with short duration of diabetes, little comorbidity, and long life expectancy. Consider less stringent A1C targets (e.g., 8 percent) for people with a history of severe hypoglycemia, limited life expectancy, extensive comorbid conditions, advanced complications, major impairments to self-management (e.g., visual, cognitive, social), or long-standing diabetes where the A1C goal is difficult to attain despite optimal efforts. Reassess A1C targets and change (lower or higher) as appropriate. From: National Diabetes Education Program website on Guiding Principles, When interpreting laboratory results health care providers should: be informed about the A1C assay methods used by their laboratory send blood samples for diagnosis to a laboratory that uses an NGSP-certified method for A1C analysis to ensure the results are standardized consider the possibility of interference in the A1C test when a result is above 15% or is at odds with other diabetes test results consider each patient’s profile, including risk factors and history, and individualize diagnosis and treatment decisions in discussion with the patient From: National Diabetes Information Clearinghouse (NDIC), Links to clinical guidelines from other organizations are listed below; the NGSP does not endorse specific guideli Continue reading >>
