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Ada Management Of Type 2 Diabetes

Guidelines For The Management Of Type 2 Diabetes: Is Ada And Easd Consensus More Clinically Relevant Than The Idf Recommendations?

Guidelines For The Management Of Type 2 Diabetes: Is Ada And Easd Consensus More Clinically Relevant Than The Idf Recommendations?

1. Diabetes Res Clin Pract. 2009 Dec;86 Suppl 1:S22-5. doi:10.1016/S0168-8227(09)70005-1. Guidelines for the management of type 2 diabetes: is ADA and EASD consensus more clinically relevant than the IDF recommendations? (1)Internal Diseases and Diabetology Department, Medical University of Lodz, Poland. [email protected] Recently, American Diabetes Association (ADA) and European Association for theStudy of Diabetes (EASD) as well as International Diabetes Federation (IDF) have all issued their recommendations on the management of type 2 diabetes. Despitethe same objectives, these guidelines are substantially different in terms oftarget values of glucose control, strategies for drug choice etc. ADA/EASDguidelines offer practical algorithm to help initiate and modify pharmacological therapy for diabetes, with detailed descriptions of treatment options. IDFdocument, however, concentrates on the role of postprandial hyperglycemia andcalls for lower HbA1c target value of 6.5% as opposed to ADA/EASD guidelinesadvocating value of 7%. Careful analysis of the guidelines contents suggests thatADA/EASD consensus might be more useful in everyday clinical practice than IDFrecommendations, which do not offer a particular treatment algorithm.Copyright 2009 Elsevier Ireland Ltd. All rights reserved. Continue reading >>

Type 2 Diabetes Glucose Management Goals

Type 2 Diabetes Glucose Management Goals

Optimal management of type 2 diabetes requires treatment of the “ABCs” of diabetes: A1C, blood pressure, and cholesterol (ie, dyslipidemia). This web page provides the rationale and targets for glucose management; AACE guidelines for blood pressure and lipid control are summarized in Management of Common Comorbidities of Diabetes. Glucose Targets Glucose goals should be established on an individual basis for each patient, based on consideration of both clinical characteristics and the patient's psycho-socioeconomic circumstances.1-3 Accordingly, AACE recommends individualized glucose targets (Table 1) that take into account the following factors1,2: Life expectancy Duration of diabetes Presence or absence of microvascular and macrovascular complications Comorbid conditions including CVD risk factors Risk for development of or consequences from severe hypoglycemia Patient's social, psychological, and economic status Table 1. AACE-Recommended Glycemic Targets for Nonpregnant Adults1,2 Parameter Treatment Goal Hemoglobin A1C Individualize on the basis of age, comorbidities, and duration of disease ≤6.5 for most Closer to normal for healthy Less stringent for “less healthy” Fasting plasma glucose (FPG) <110 mg/dL 2-hour postprandial glucose (PPG) <140 mg/dL The American Diabetes Association (ADA) also recommends individualizing glycemic targets (Table 2) based on patient-specific characteristics3: Patient attitude and expected treatment efforts Risks potentially associated with hypoglycemia as well as other adverse events Disease duration Life expectancy Important comorbidities Established vascular complications Resources and support system Table 2. ADA-Recommended Glycemic Targets for Nonpregnant Adults3 Parameter Treatment Goal Hemoglobin A1C <6.5% for patients 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 >>

Primary Care Doctors Loosen Type 2 Diabetes Goals

Primary Care Doctors Loosen Type 2 Diabetes Goals

Primary Care Doctors Loosen Type 2 Diabetes Goals TUESDAY, March 6, 2018 (HealthDay News) -- The American College of Physicians (ACP) has issued new guidance on managing type 2 diabetes -- including relaxing the long-term blood sugar target called hemoglobin A1C. The A1C is a blood test that gives doctors an estimate of your blood sugar level average over the past few months. For most adults, the American Diabetes Association recommends a target A1C of below 7 percent. This goal may be altered based on individual circumstances. However, the new ACP guidance suggests that A1C should be between 7 and 8 percent for most adults with type 2 diabetes . For adults who achieve an A1C below 6.5 percent, the group suggests stepping down diabetes treatment to keep that level from going even lower. The American College of Physicians, which is a national organization of internal medicine doctors, also says that management goals should be personalized based on the benefits and risks of medications, patient preference, general health status and life expectancy. And, though the doctors' group has relaxed the suggested A1C targets, that doesn't mean type 2 diabetes isn't a serious problem. "These changes should in no way be interpreted as diabetes is unimportant," said Dr. Jack Ende, ACP's president. More than 29 million Americans have diabetes. Over time, high blood sugar levels can lead to vision loss, nerve problems, heart attacks, strokes and kidney failure. "Diabetes is such a prevalent problem, and there are so many guidelines and conflicting information out there, we wanted to do an assessment that would give our members the best possible advice," Ende said. "Also, A1C targets are being used now as a performance measure." And, when insurers expect all patients to fall under a ce Continue reading >>

What To Know About The Ada's 2018 Standards Of Medical Care If You Have Diabetes

What To Know About The Ada's 2018 Standards Of Medical Care If You Have Diabetes

Living with poorly controlled blood sugar levels may lead to potentially serious health complications for people with diabetes — including diabetic neuropathy, diabetic retinopathy, amputations, depression, sexual issues, heart disease, stroke, and even death. But luckily, if you have type 1 or type 2 diabetes, managing your diet, lifestyle, and treatment well can help you stabilize blood sugar and ultimately reduce the risk of these potential future health issues. To do this, it’s crucial to stay up to date on current treatment standards in the United States — and that starts with turning to the American Diabetes Association (ADA), which releases its Standards of Medical Care each year. What Are the ADA Standards of Care and Why Should You Care? In the ADA’s latest guidelines, released online in December 2017, the organization lists updates in areas related to heart disease and diabetes, new health technology, and more. The standards reflect the latest evidence available to help improve care and health outcomes in people with diabetes, says William T. Cefalu, MD, the chief scientific, medical, and mission officer at the ADA who is based in New Orleans, Louisiana. “The new evidence that has been available this year from published work has been incredible,” Dr. Cefalu says. Although the Standards of Medical Care are primarily geared toward the healthcare community, your diabetes management can benefit if you know about them, says Robert A. Gabbay, MD, PhD, the chief medical officer of the Joslin Diabetes Center in Boston. Following is everything you need to know about the new guidelines if you or a family member has type 1 diabetes, type 2 diabetes, or gestational diabetes. What the 2018 ADA Standards of Medical Care Say Here are some of the major changes and Continue reading >>

Pharmacologic Therapy For Type 2 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Pharmacologic Therapy For Type 2 Diabetes: Synopsis Of The 2017 American Diabetes Association Standards Of Medical Care In Diabetes Free

Abstract Description: The American Diabetes Association (ADA) annually updates the Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. Methods: For the 2017 Standards, the ADA Professional Practice Committee updated previous MEDLINE searches performed from 1 January 2016 to November 2016 to add, clarify, or revise recommendations based on new evidence. The committee rates the recommendations as A, B, or C, depending on the quality of evidence, or E for expert consensus or clinical experience. The Standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions. Recommendations: This synopsis focuses on recommendations from the 2017 Standards about pharmacologic approaches to glycemic treatment of type 2 diabetes. The American Diabetes Association (ADA) first released its Standards of Medical Care in Diabetes for health professionals in 1989. These practice guidelines provide an extensive set of evidence-based recommendations that are updated annually for the diagnosis and management of patients with diabetes. The 2017 Standards cover all aspects of patient care (1); this guideline synopsis focuses on pharmacologic approaches for patients with type 2 diabetes. Pharmacologic Therapy for Type 2 Diabetes: Recommendations Initial Treatment Approach: Metformin Assessing Response and Deciding to Intensify Therapy Recent Evidence From Cardiovascular Outcomes Trials Recent Warnings About Pharmacotherapies Insulin Therapy Continue reading >>

Pharmacologic Management Of Type 2 Diabetes Mellitus: Available Therapies

Pharmacologic Management Of Type 2 Diabetes Mellitus: Available Therapies

Choices for the treatment of type 2 diabetes mellitus (T2DM) have multiplied as our understanding of the underlying pathophysiologic defects has evolved. Treatment should target multiple defects in T2DM and follow a patient-centered approach that considers factors beyond glycemic control, including cardiovascular risk reduction. The American Association of Clinical Endocrinologists/American College of Endocrinology and the American Diabetes Association recommend an initial approach consisting of lifestyle changes and monotherapy, preferably with metformin. Therapy choices are guided by glycemic efficacy, safety profiles, particularly effects on weight and hypoglycemia risk, tolerability, patient comorbidities, route of administration, patient preference, and cost. Balancing management of hyperglycemia with the risk of hypoglycemia and consideration of the effects of pharmacotherapy on weight figure prominently in US-based T2DM recommendations, whereas less emphasis has been placed on the ability of specific medications to affect cardiovascular outcomes. This is likely because, until recently, specific glucose-lowering agents have not been shown to affect cardiorenal outcomes. The Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients–Removing Excess Glucose (EMPA-REG OUTCOME), the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial, and the Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes 6 (SUSTAIN-6) recently showed a reduction in overall cardiovascular risk with empagliflozin, liraglutide, and semaglutide treatment, respectively. Moreover, empagliflozin has become the first glucose-lowering agent indicated to reduce the ri Continue reading >>

Management Of Type 2 Diabetes In Youth: An Update

Management Of Type 2 Diabetes In Youth: An Update

Management of Type 2 Diabetes in Youth: An Update KEVIN PETERSON, MD, MPH, University of Minnesota Medical School, Minneapolis, Minnesota JANET SILVERSTEIN, MD, University of Florida College of Medicine, Gainesville, Florida FRANCINE KAUFMAN, MD, Childrens Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, California ELIZABETH WARREN-BOULTON, RN, MSN, Hager Sharp, Washington, D.C. Am Fam Physician.2007Sep1;76(5):658-664. Patient information: See related handout on type 2 diabetes in youth , written by the authors of this article. This article exemplifies the AAFP 2007 Annual Clinical Focus on management of chronic illness. Although type 1 diabetes historically has been more common in patients eight to 19 years of age, type 2 diabetes is emerging as an important disease in this group. Type 2 diabetes accounts for 8 to 45 percent of new childhood diabetes. This article is an update from the National Diabetes Education Program on the management of type 2 diabetes in youth. High-risk youths older than 10 years have a body mass index greater than the 85th percentile for age and sex plus two additional risk factors (i.e., family history, high-risk ethnicity, acanthosis nigricans, polycystic ovary syndrome, hypertension, or dyslipidemia). Reducing overweight and impaired glucose tolerance with increased physical activity and healthier eating habits may help prevent or delay the development of type 2 diabetes in high-risk youths. The American Academy of Pediatrics does not recommend population-based screening of high-risk youths; however, physicians should closely monitor these patients because early diagnosis may be beneficial. The American Diabetes Association recommends screening high-risk youths every two years with a fa Continue reading >>

Idf Clinical Practice Recommendations For Managing Type 2 Diabetes In Primary Care

Idf Clinical Practice Recommendations For Managing Type 2 Diabetes In Primary Care

IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care - 2017 2 IDF Working Group Chair: Pablo Aschner, MD,MSc, Javeriana University and San Ignacio University Hospital, Bogota, Colombia. Core Contributors: Amanda Adler, MD, PhD, FRCP, Addenbrooke´s Hospital and National Institute for Health and Care Excellence(NICE), Cambridge, UK Cliff Bailey, PhD, FRCP(Edin), FRCPath, Aston University, Birmingham,UK Juliana CN Chan, MB ChB, MD, MRCP (UK), FRCP (Lond), FRCP (Edin), FRCP (Glasgow), FHKAM (Medicine), Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong and Prince of Wales Hospital, Hong Kong, China. Stephen Colagiuri, MB, BS Honours Class II, FRACP, The Boden Institute, University of Sydney, Sydney, Australia Caroline Day, PhD, FRSB, MedEd UK and Aston University, Birmingham, UK Juan Jose Gagliardino, MD, Cenexa (Unlp-Conicet), La Plata, Argentina Lawrence A. Leiter, MD, FRCPC, FACP, FACE, FAHA, Clinical Nutrition and Risk Factor Modification Centre, Li Ka Shing Knowledge Institute at St. Michael’s Hospital and University of Toronto, Toronto, Canada Shaukat Sadikot, MD, President International Diabetes Federation (2016-2017), Diabetes India and Jaslok Hospital, Mumbai, India Nam Han Cho, MD, PhD, President-Elect International Diabetes Federation (2016-17), Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea Eugene Sobngwi, MD, MPhil, PhD, Central Hospital and University of Yaounde, Yaounde, Cameroon Acknowledgements Milena Garcia, MD, MSc, Javeriana University and San Ignacio University Hospital, Bogota, Colombia. Co-chaired the consensus meeting and contributed to the appraisal of the guidelines Chris Parkin - Medical writing support, CGParkin Communications, USA Martine V Continue reading >>

Diabetes Mellitus Type 2

Diabetes Mellitus Type 2

Diabetes mellitus type 2 (also known as type 2 diabetes) is a long-term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[6] Common symptoms include increased thirst, frequent urination, and unexplained weight loss.[3] Symptoms may also include increased hunger, feeling tired, and sores that do not heal.[3] Often symptoms come on slowly.[6] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[1] The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.[4][5] Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.[1] Some people are more genetically at risk than others.[6] Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.[1] In diabetes mellitus type 1 there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas.[12][13] Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).[3] Type 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly.[1] Treatment involves exercise and dietary changes.[1] If blood sugar levels are not adequately lowered, the medication metformin is typically recommended.[7][14] Many people may eventually also require insulin injections.[9] In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills.[15] Bariatri Continue reading >>

Ada Issues New Type 2 Diabetes Treatment Guidelines

Ada Issues New Type 2 Diabetes Treatment Guidelines

ADA Issues New Type 2 Diabetes Treatment Guidelines The new guidelines emphasize tailoring treatment to the needs of specific patients. After several years of preparation, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) have released new guidelines on the management of hyperglycemia in patients with type 2 diabetes mellitus (T2DM). The guidelines, which emphasize tailoring treatment to the needs of specific patients, were released online today in Diabetes Care. The guidelines note that glycemic management in T2DM is complicated by the increasing number of medications available to treat it, concerns about potential adverse consequences of these medications, and uncertainty regarding the microvascular and cardiovascular effects of intensive glycemic control. As a result, many clinicians are confused as to optimal treatment strategies. The ADAs Standards of Medical Care in Diabetes recommends reducing diabetes patients glycated hemoglobin (A1C) to less than 7.0% to reduce the incidence of microvascular disease. As long as hyperglycemia and significant side effects are guarded against, targets of 6.0% to 6.5% are considered appropriate for patients with recent disease onset, long life expectancy, and absence of cardiovascular disease. Targets of 7.5% to 8.0%, however, can be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced complications, extensive comorbid conditions, or trouble meeting glycemic targets despite multipronged therapy. Lifestyle interventions including modified diet, increased physical activity, and weight loss are critical for all diabetes patients. For highly motivated patients with an A1C less than 7.5%, the guidelines recommend pursuing lifestyle interve Continue reading >>

Type 2 Diabetes Management: Applying The Ada/easd Position Statement On Patient-centered Management

Type 2 Diabetes Management: Applying The Ada/easd Position Statement On Patient-centered Management

Please confirm that you would like to log out of Medscape.If you log out, you will be required to enter your username and password the next time you visit. Log out Cancel Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012;55:1577-1596. Abstract Inzucchi SE, Bergenstal RM, Buse JB, et al; American Diabetes Association (ADA); European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364-1379. Abstract Institute of Medicine (IOM). Committee on Quality of Health Care in America: Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001. Accessed May 3, 2013. Ismail-Beigi F, Moghissi E, Tiktin M, Hirsch IB, Inzucchi SE, Genuth S. Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann Intern Med. 2011;154:554-549. Abstract ClinicalTrials.gov. A Comparative Effectiveness Study of Major Glycemia-lowering Medications for Treatment of Type 2 Diabetes (GRADE). NCT01794143. Accessed May 3, 2013. Sasali A, Leahy JL. Insulin therapy for type 2 diabetes. Curr Diab Rep. 2003;3:378-385. Abstract Yki-Jrvinen H, Ryysy L, Nikkil K, Tulokas T, Vanamo R, Heikkil M. Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med. 1999;130:389-396. Abstract Avils-S 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 >>

Challenges In The Management Of Type 2 Diabetes In The Elderly

Challenges In The Management Of Type 2 Diabetes In The Elderly

Challenges in the Management of Type 2 Diabetes in the Elderly US Endocrinology, 2008;4(1):47-50 DOI: Citation US Endocrinology, 2008;4(1):47-50 DOI: It is estimated that diabetes currently affects 195 million people worldwide. This figure is expected to rise to over 330 million by 2030.1,2 The overwhelming scale of the problem will present significant challenges to healthcare systems and clinical practices. Furthermore, the population in general is aging. Both the prevalence and the incidence of type 2 diabetes rise with increasing age, leading to a large rise in the number of elderly people with diabetes: approximately 15% of people over 60 years of age in the US are affected by diabetes, and it is estimated that half of all type 2 diabetes cases occur in those above 65 years of age.3 In Europe, data from the Diabetes Epidemiology: Collaborative Analysis Of Diagnostic Criteria in Europe (DECODE) study suggest that the prevalence of diabetes is 1020% in those 60 and 69 years of age, rising to 1520% in the oldest age groups.4 The management of diabetes in the elderly has unique challenges. With increasing age, there is an increased prevalence of comorbid illnesses and functional disability that contributes to the complexity of managing diabetes in the elderly cohort. Thus, treatment must take into consideration not only the standard micro- and macrovascular complications associated with both aging and diabetes, but also conditions such as cognitive impairment and impaired function. Importantly, elderly patients with diabetes have an increased risk for cardiovascular disease.5 The diagnosis of diabetes in the elderly also presents challenges, and it is estimated that half of the elderly population with diabetes are not diagnosed correctly with the condition. This is due Continue reading >>

Management Of Hyperglycemia In Type 2 Diabetes: A Patient-centered Approach

Management Of Hyperglycemia In Type 2 Diabetes: A Patient-centered Approach

Glycemic management in type 2 diabetes mellitus has become increasingly complex and, to some extent, controversial, with a widening array of pharmacological agents now available (1–5), mounting concerns about their potential adverse effects and new uncertainties regarding the benefits of intensive glycemic control on macrovascular complications (6–9). Many clinicians are therefore perplexed as to the optimal strategies for their patients. As a consequence, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a joint task force to examine the evidence and develop recommendations for antihyperglycemic therapy in nonpregnant adults with type 2 diabetes. Several guideline documents have been developed by members of these two organizations (10) and by other societies and federations (2,11–15). However, an update was deemed necessary because of contemporary information on the benefits/risks of glycemic control, recent evidence concerning efficacy and safety of several new drug classes (16,17), the withdrawal/restriction of others, and increasing calls for a move toward more patient-centered care (18,19). This statement has been written incorporating the best available evidence and, where solid support does not exist, using the experience and insight of the writing group, incorporating an extensive review by additional experts (acknowledged below). The document refers to glycemic control; yet this clearly needs to be pursued within a multifactorial risk reduction framework. This stems from the fact that patients with type 2 diabetes are at increased risk of cardiovascular morbidity and mortality; the aggressive management of cardiovascular risk factors (blood pressure and lipid therapy, antiplatelet treatment, and Continue reading >>

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