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Type 2 Diabetes: New Guidelines Lower Blood Sugar Control Levels

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 >>

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

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

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

Overview Of Medical Care In Adults With Diabetes Mellitus

Overview Of Medical Care In Adults With Diabetes Mellitus

INTRODUCTION The estimated overall prevalence of diabetes among adults in the United States ranges from 5.8 to 12.9 percent (median 8.4 percent) [1,2]. More personal health care resources are estimated to be spent on diabetes than any other condition [3]. Numerous factors, in addition to directly related medical complications, contribute to the impact of diabetes on quality of life and economics. Diabetes is associated with a high prevalence of depression [4] and adversely impacts employment, absenteeism, and work productivity [5]. This review will provide an overview of the medical care for patients with diabetes (table 1). The management approach is consistent with guidelines from the American Diabetes Association (ADA) for health maintenance in patients with diabetes, which are published yearly [6]. Consensus recommendations for the management of glycemia in type 2 diabetes were published in 2006 and are updated regularly. Detailed discussions relating to screening, diagnosis, and management of hyperglycemia are discussed separately. (See "Screening for type 2 diabetes mellitus" and "Clinical presentation and diagnosis of diabetes mellitus in adults" and "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Management of persistent hyperglycemia in type 2 diabetes mellitus".) EVALUATION Initial — Patients with newly diagnosed diabetes require a history and physical examination to assess the characteristics of onset of diabetes (asymptomatic laboratory finding or symptomatic polyuria and polydipsia), nutrition and weight history, physical activity, cardiovascular risk factors, history of diabetes-related complications, hypoglycemic episodes, diabetic ketoacidosis (DKA) frequency (type 1 diabetes only), and current management. Although th Continue reading >>

Diagnosis

Diagnosis

Print Symptoms of type 1 diabetes often appear suddenly and are often the reason for checking blood sugar levels. Because symptoms of other types of diabetes and prediabetes come on more gradually or may not be evident, the American Diabetes Association (ADA) has recommended screening guidelines. The ADA recommends that the following people be screened for diabetes: Anyone with a body mass index higher than 25, regardless of age, who has additional risk factors, such as high blood pressure, a sedentary lifestyle, a history of polycystic ovary syndrome, having delivered a baby who weighed more than 9 pounds, a history of diabetes in pregnancy, high cholesterol levels, a history of heart disease, and having a close relative with diabetes. Anyone older than age 45 is advised to receive an initial blood sugar screening, and then, if the results are normal, to be screened every three years thereafter. Tests for type 1 and type 2 diabetes and prediabetes Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates that you have diabetes. An A1C between 5.7 and 6.4 percent indicates prediabetes. Below 5.7 is considered normal. If the A1C test results aren't consistent, the test isn't available, or if you have certain conditions that can make the A1C test inaccurate — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — your doctor may use the following tests to diagnose diabetes: Random blood sugar Continue reading >>

Diabetes Care Standards

Diabetes Care Standards

This section shares resources that provide evidence-based guidelines to support and improve care for people with diabetes. Diabetes care is complex and requires that many issues be addressed beyond blood glucose management. Diabetes care should consider individual preferences, comorbidities, and other patient factors that may require modification of goals and targets to meet the needs of the individual with diabetes. Many evidence-based guidelines for diabetes care exist and are promoted by several organizations. Guiding Principles for the Care of People With or At Risk for Diabetes The National Diabetes Education Program (NDEP) maintains a set of clinically useful principles that highlight areas of agreement in diabetes management and prevention. This resource, the Guiding Principles for the Care of People With or At Risk for Diabetes , provides health care professionals a set of 10 guiding principles that highlight areas of agreement for diabetes care. More than a dozen federal agencies and professional organizations support this document. The goal of any set of guidelines is to improve patient outcomes. A part of quality improvement or pay-for-performance measures may include collection of data from health care practices to document the achievement of these goals. A variety of organizations provide recommendations to assist with the screening, prevention, and management of diabetes. Recommendations can be based on a systematic review of the literature, review of existing guidelines, or best practice advice. Below is a list of organizations and the diabetes practice guidelines they provide: Continue reading >>

Diabetes Guidelines Relax Blood Sugar Management

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 >>

Tailoring Treatment To Reduce Disparities:

Tailoring Treatment To Reduce Disparities:

The American Diabetes Association (ADA) publishes the Standards of Medical Care in Diabetes annually, based on the latest medical research. The following narrative provides a summary of the 2017 updated recommendations that have been developed for clinical practice. The ADA guidelines are not intended to aid or preclude clinical judgment. The full guidelines can be accessed at ADA’s Diabetes Pro website. Tailoring Treatment to Reduce Disparities: Updated guidelines focus on improving outcomes and reducing disparities in populations with diabetes such as: Ethnic/Cultural/Sex/Socioeconomic Differences and Disparities: Provide structured interventions that are tailored to ethnic populations and integrate culture, language, religion, and literacy skills. Food Insecurity: Evaluate hyperglycemia and hypoglycemia in the context of food insecurity (FI), which is defined as the unreliable availability of nutritious food. Recognize that homelessness and poor literacy and numeracy often occur with FI. Propose solutions and resources accordingly. Comprehensive Medical Evaluation and Assessment of Comorbidities: The clinical evaluation should include conversation about lifestyle modifications and healthy living. PAs should address barriers including patient factors (e.g., remembering to obtain or take medications, fears, depression, and health beliefs), medication factors (e.g., complex directions, cost) and system factors (e.g., inadequate follow up). Simplifying treatment regimens may improve adherence. This section highlights the elements of a patient-centered comprehensive medical exam, including the importance of assessing comorbidities such as: Cognitive Dysfunction: Tailor glycemic therapy to avoid significant hypoglycemia. Cardiovascular benefits of statin therapy outweigh Continue reading >>

Diabetes: New Recommendations

Diabetes: New Recommendations

New Diabetes Recommendations Challenge Decades-Old Guidelines Written by Ginger Vieira on March 5, 2018 Major new report advises some people with type 2 diabetes to cut down on meds. A new report is challenging decades of diabetes treatment dogma by advising that people with type 2 diabetes should have more relaxed targets for a blood protein used to help monitor blood sugar levels. Some patients are even advised to de-intensify their medication or go off it altogether. The recommendations from the American College of Physicians (ACP) centers around a protein called hemoglobin HbA1C or A1C , which is key in helping people with diabetes to monitor their average blood sugar level. Sugars or glucose bind to hemoglobin as they travel through the bloodstream. For years, the American Diabetes Association (ADA) has recommended that all people with diabetes aim for a target hemoglobin HbA1C level below 7 percent. Even more stringent, the American Association of Clinical Endocrinologists (AACE) recommends A1C targets below 6.5 percent. But the recent report from the ACP completely contradicts the ADA and the AACE. It recommends most patients with type 2 diabetes should aim for much higher A1Cs between 7 and 8 percent. Your A1C measures the amount of advanced glycogenated end products (AGEs) that have accumulated in your bloodstream during the prior three months. This measurement is then translated into a persons average blood sugar level for this time, also known as your estimated average glucose (eAG) . The ACP recommendation works directly against decades worth of diabetes education guidelines that suggest an A1C over 7 percent increases a persons risk of developing diabetes complications such as retinopathy and neuropathy. People without diabetes generally measure with A1Cs Continue reading >>

Ada Releases 2018 Standards Of Care For Diabetes

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 >>

Treatment Of T2dm | Outpatient.aace.com

Treatment Of T2dm | Outpatient.aace.com

Every patient with documented type 2 diabetes (T2D) should have a comprehensive care plan (CCP), which takes into account the patients unique medical history, behaviors and risk factors, ethnocultural background, and environment. The ultimate goal of the CCP is to reduce the risk of diabetes complications without jeopardizing patient safety. To achieve this goal, the CCP should include the following components:1 The multidisciplinary team typically oversees the medical management of T2D, including the prescription of antihyperglycemic therapy and the delivery of diabetes self-management education (DSME) . DSME is used to educate the patient on the components of therapeutic lifestyle changes, namely medical nutritional therapy (MNT) and physical activity. Each patients understanding of and participation in the CCP is essential to its success.1 The components of therapeutic lifestyle change include:1 Nutritional medicine for diabetes involves counseling about general healthful eating, MNT, as well as nutritional support when appropriate (eg, in patients receiving enteral or parenteral nutrition in which medications provided for glycemic control must be synchronized with carbohydrate delivery; see AACE Inpatient Glycemic Control Resource Center for more information).1 Either the physician or a registered dietitian (RD) should discuss healthful eating recommendations in plain language at diagnosis of T2D and then periodically during follow-up office visits (Table 1). These recommendations are suitable for the general population, including people without diabetes, and focus on foods that can promote health vs foods that may promote disease or complications. Discussions should cover specific foods, dishes, meal planning, grocery shopping, and dining-out strategies.1 Table 1. Continue reading >>

Controversial New A1c Recommendations For Diabetes: What To Know | Everyday Health

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 >>

Updated Type 1 Diabetes Treatment Guidelines

Updated Type 1 Diabetes Treatment Guidelines

This article requires a subscription for full access. NEJM Journal Watch articles published within the last six months are available to subscribers only. Articles published more than 6 months ago are available to registered users. Continue reading >>

Guidelines

Guidelines

There is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those living with the condition. Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefit. Reasons include the size and complexity of the evidence-base, and the complexity of diabetes care itself. One result is a lack of proven cost-effective resources for diabetes care. Another result is diversity of standards of clinical practice. Guidelines are part of the process which seeks to address those problems. IDF has produced a series of guidelines on different aspects of diabetes management, prevention and care. The new IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care seek to summarise current evidence around optimal management of people with type 2 diabetes. It is intended to be a decision support tool for general practitioners, hospital based clinicians and other primary health care clinicians working in diabetes. Pocket chart in the format of a Z-card with information for health professionals to identify, assess and treat diabetic foot patients earlier in the "window of presentation" between when neuropathy is diagnosed and prior to developing an ulcer. The content is derived from the IDF Clinical Practice Recommendations on the Diabetic Foot 2017. Available to download and to order in print format. The IDF Clinical Practice Recommendations on the Diabetic Foot are simplified, easy to digest guidelines to prioritize health care practitioner's early intervention of the diabetic foot with a sense of urgency through education. The main aims of the guidelines are to promote early detection and intervention; provide the criteria for Continue reading >>

New Treatment Guidelines For Diabetes

New Treatment Guidelines For Diabetes

Authors: News Author: Miriam E Tucker; CME Author: Charles P. Vega, MD, FAAFP Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s) Family Physicians - maximum of 0.25 AAFP Prescribed credit(s) ABIM Diplomates - maximum of 0.25 ABIM MOC points Nurses - 0.25 ANCC Contact Hour(s) (0.25 contact hours are in the area of pharmacology) Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs) This article is intended for primary care physicians, endocrinologists, obstetrician-gynecologists, nurses, pharmacists, and other clinicians who care for individuals with diabetes. The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care. Upon completion of this activity, participants will be able to: Distinguish appropriate glycemic targets for patients with diabetes Assess best practices in the pharmacologic treatment of diabetes As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest. Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content. Disclosure: Miriam E. Tucker has disclosed no relevant financial relationships. Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships. Health Sciences Clinical Professor, Univer 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 >>

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