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Management Of Hyperglycemia In Type 2 Diabetes 2015

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 >>

Type 2 Diabetes Mellitus: Outpatient Insulin Management

Type 2 Diabetes Mellitus: Outpatient Insulin Management

In patients with type 2 diabetes mellitus, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy. The American Diabetes Association suggests the use of long-acting (basal) insulin to augment therapy with one or two oral agents or one oral agent plus a glucagon-like peptide 1 receptor agonist when the A1C level is 9% or more, especially if the patient has symptoms of hyperglycemia or catabolism. Insulin regimens should be adjusted every three or four days until targets of self-monitored blood glucose levels are reached. A fasting and premeal blood glucose goal of 80 to 130 mg per dL and a two-hour postprandial goal of less than 180 mg per dL are recommended. Insulin use is associated with hypoglycemia and weight gain. Insulin analogues are as effective as human insulin at lowering A1C levels with lower risk of hypoglycemia, but they have significantly higher cost. Patients with one or more episodes of severe hypoglycemia (i.e., requiring assistance from others for treatment) may benefit from a short-term relaxation of glycemic targets. Several new insulin formulations have been approved recently that are associated with less risk of hypoglycemia compared with older formulations. The goals of therapy should be individualized based on many factors, including age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia, cost, patient motivation, and quality of life. Type 2 diabetes mellitus is a chronic, progressive disease characterized by multiple defects in glucose metabolism, the core of which is insulin resistance in muscle, liver, and adipocytes and progressive beta cell failure.1 Beta cell failure progresses at a rate of approximately 4% per year, requiring the use of multiple medications, oft Continue reading >>

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

Management Of Persistent Hyperglycemia In Type 2 Diabetes Mellitus

The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc. All topics are updated as new evidence becomes available and our peer review process is complete. INTRODUCTION — Initial treatment of patients with type 2 diabetes mellitus includes education, with emphasis on lifestyle changes including diet, exercise, and weight reduction when appropriate. Monotherapy with metformin is indicated for most patients, and insulin may be indicated for initial treatment for some [1]. Although several studies have noted remissions of type 2 diabetes mellitus that may last several years, most patients require continuous treatment in order to maintain normal or near-normal glycemia. Bariatric surgical procedures in obese patients that result in major weight loss have been shown to lead to remission in a substantial fraction of patients. Regardless of the initial response to therapy, the natural history of most patients with type 2 diabetes is for blood glucose concentrations to rise gradually with time. Treatment for hyperglycemia that fails to respond to initial monotherapy and long-term pharmacologic therapy in type 2 diabetes is reviewed here. Options for initial therapy and other therapeutic issues in diabetes management, such as the frequency of monitoring and evaluation for microvascular and macrovascular complications, are discussed separately. (See "Initial management of blood glucose in adults with type 2 diabetes mellitus" and "Overview of medical care in adults with diabetes mellitus". Continue reading >>

Synopsis Of The 2016 Ada Standards Of Medical Care In Diabetes | Annals Of Internal Medicine | American College Of Physicians

Synopsis Of The 2016 Ada Standards Of Medical Care In Diabetes | Annals Of Internal Medicine | American College Of Physicians

Author, Article, and Disclosure Information This article was published at www.annals.org on 1 March 2016. From St. Mark's Hospital and St. Mark's Diabetes Center, Salt Lake City, Utah; Glytec, Greenville, South Carolina; and University Physicians Primary Care, Augusta, Georgia. Acknowledgment: The authors thank Sarah Bradley; Jane Chiang, MD; Matt Petersen; and Jay Shubrook, DO, for their invaluable assistance in the writing of this manuscript. Disclosures: Dr. Chamberlain reports personal fees (speakers bureau) from Merck, Sanofi Aventis, and Janssen during the conduct of the study. Dr. Rhinehart reports personal fees from Sanofi, Novo Nordisk, AstraZeneca, Boehringer Ingelheim, Janssen, Eli Lilly, Forest, and Glytec outside the submitted work. Dr. Shaefer reports personal fees from Sanofi, Eli Lilly, AstraZeneca, Boehringer Ingelheim, Janssen, Forest Pharmaceuticals, and Vivus; and nonfinancial support from Sanofi outside the submitted work. Ms. Neuman has disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-3016 . Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relations Continue reading >>

Newer Agents In Type 2 Diabetes

Newer Agents In Type 2 Diabetes

A 61-year-old man has a 12-year history of type 2 diabetes. Other medical problems include hypertension, hyperlipidemia, coronary artery disease (CAD), diastolic dysfunction, gout, and benign prostatic hyperplasia (BPH). His current antihyperglycemic regimen consists of metformin and sitagliptin. His blood glucose levels at home have increased over the past year, so that he is now running 150-170 mg/dl range fasting, and frequently >200 mg/dl during the day. His A1c, which had been previously maintained between 7.0% and 7.5%, has increased over the past six months to 8.3%. CAD s/p left anterior descending (LAD) artery stent (drug-eluting) three years ago (last nuclear stress test without ischemia) Social History: Former smoker; no excess alcohol. Works as an accountant. Married withtwo grown children. Family History: Type 2 diabetes in both parents. ROS: No chest pain but mild exertional dyspnea. No edema. Mild obstructive voiding symptoms. Physical Examination: Obese man in no apparent distress. Body mass index (BMI) 35.2 kg/m2. BP 146/92. HR 72 regular RR 18 afebrile. No jugular venous distension. Carotid upstrokes normal. Abdomen obese but no masses or tenderness Normal chemistries; estimated glomerular filtration rate (eGFR) >90 Low-density lipoprotein (LDL) 63, high-density lipoprotein (HDL) 45, TGs 167 Electrocardiogram: Left ventricular hypertrophy (LVH) but no ischemic changes Assessment: 61-year-old man with suboptimal blood glucose control on dual therapy with metformin and a DPP-4 inhibitor, in the setting of well-controlled hypertension and hyperlipidemia and a history of CAD and diastolic dysfunction. Choosing an HbA1c target is the first step in this patient's diabetes care to determine how much further glucose lowering is optimal for him. Based on his ag Continue reading >>

Ada/easd Guidelines Hyperglycemia Management In Type 2 Diabetes | Ndei

Ada/easd Guidelines Hyperglycemia Management In Type 2 Diabetes | Ndei

If A1C target is not achieved after 3 months of dual therapy, proceed to Triple Therapy If A1C target is not achieved after 3 months of triple therapy and patient (1) is on oral combination, move to injectable; (2) on GLP-1, add basal insulin; or (3) on optimally titrated basal insulin, add GLP-1 or mealtime insulin. Refractory patients: consider adding TZD or SGLT2. Basal insulin + mealtime insulin or GLP-1 If not controlled after FBG target is reached or if dose >0.5 U/kg/d Add 1 rapid insulin injection before largest meal 4 U, 0.1 U/kg, or 10% basal dose. If A1C <8%, consider decreasing basal dose by same amount Increase dose by 1-2U or 10-15% once to twice weekly until SMBG target is reached Decrease corresponding dose by 2-4U or 10-20% for hypoglycemia Divide current basal dose into 2/3 AM, 1/3 PM, or 1/2 AM, 1/2 PM Increase dose by 1-2U or 10-15% once to twice weekly to reach SMBG target Decrease corresponding dose by 2-4U or 10-20% for hypoglycemia Add 2 rapid insulin injections before meals: basal-bolus 4 U, 0.1 U/kg, or 10% basal dose/meal. If A1C <8%, consider decreasing basal by same amount Increase dose by 1-2U or 10-15% once to twice weekly until SMBG target is reached Decrease corresponding dose by 2-4U or 10-20% for hypoglycemia Continue reading >>

Management Of Hyperglycemia In Type 2 Diabetes, 2015: A Patient-centered Approach: Update To A Position Statement Of The American Diabetes Association And The European Association For The Study Of Diabetes

Management Of Hyperglycemia In Type 2 Diabetes, 2015: A Patient-centered Approach: Update To A Position Statement Of The American Diabetes Association And The European Association For The Study Of Diabetes

Management of Hyperglycemia in Type 2 Diabetes, 2015: A Patient-Centered Approach: Update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes Silvio E. Inzucchi - Section of Endocrinology, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT Richard M. Bergenstal - Park Nicollet Health Services John B. Buse - University of North Carolina at Chapel Hill Apostolos Tsapas - Aristotle University of Thessaloniki Richard Wender - American Cancer Society, Thomas Jefferson University David R. Matthews - NIHR Oxford Musculoskeletal Biomedical Research Unit, Churchill Hospital, University of Oxford 2018 Digital Science & Research Solutions, Inc. All Rights Reserved | About us Privacy policy Legal terms VPAT Citation Count is the number of times that this paper has been cited by other published papers in the database. The Altmetric Attention Score is a weighted count of all of the online attention Altmetric have found for an individual research output. This includes mentions in public policy documents and references in Wikipedia, the mainstream news, social networks, blogs and more. More detail on the weightings of each source and how they contribute to the attention score is available here . The Relative Citation Ratio (RCR) indicates the relative citation performance of an article when comparing its citation rate to that of other articles in its area of research. A value of more than 1.0 shows a citation rate above average. The articles area of research is defined by the articles that have been cited alongside it. The RCR is normalized to 1.0 for all articles. The Field Citation Ratio (FCR) is an article-level metric that indicates the relative citation performance of an article, when compared Continue reading >>

Advancements In Individualizing Treatment For Type 2 Diabetes: Discussion Guide

Advancements In Individualizing Treatment For Type 2 Diabetes: Discussion Guide

An increase in the prevalence of diagnosed diabetes mellitus in the United States by 382% was observed between 1988 and 2014. The vast majority (90% to 95%) of patients with diabetes have type 2 disease.[5] Risk factors for developing type 2 diabetes include advanced age, male gender, certain racial or ethnic groups (e.g., American Indians, African Americans, Hispanics/Latinos, Asians, Pacific Islanders), and low socioeconomic status.[3] Type 2 diabetes is characterized by insulin resistance and progressive pancreatic -cell dysfunction resulting in hyperglycemia and target organ damage (i.e., macrovascular and microvascular complications). These changes typically begin long before the disease is diagnosed.[5,6] Glucose homeostasis is maintained in healthy persons by pancreatic -cell release of insulin in response to high blood glucose concentrations, which promotes hepatic and skeletal muscle uptake of glucose and inhibits hepatic glucose production and lipolysis by fat cells. When blood glucose concentrations fall too low, pancreatic -cells release glucagon, which opposes the actions of insulin. Glucagon reduces glucose uptake in hepatic and muscle tissues and increases hepatic glucose production and lipolysis by fat cells. In prediabetes and the early stages of type 2 diabetes, insulin resistance in liver, muscle, and other tissues is largely overcome by compensatory increases in -cell insulin secretion, resulting in mild hyperglycemia.[3] More overt hyperglycemia manifests in later stages of the disease when -cell function deteriorates and insulin secretion is inadequate to compensate for insulin resistance. Persistent hyperglucagonemia contributes to hyperglycemia.[7] Multiple organ systems and tissues appear to be involved in the pathogenesis of type 2 diabetes. D Continue reading >>

Management Of Hyperglycemia In Type 2 Diabetes, 2015: A Patient-centeredapproach: Update To A Position Statement Of The American Diabetes Association Andthe European Association For The Study Of Diabetes.

Management Of Hyperglycemia In Type 2 Diabetes, 2015: A Patient-centeredapproach: Update To A Position Statement Of The American Diabetes Association Andthe European Association For The Study Of Diabetes.

1. Diabetes Care. 2015 Jan;38(1):140-9. doi: 10.2337/dc14-2441. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centeredapproach: update to a position statement of the American Diabetes Association andthe European Association for the Study of Diabetes. Inzucchi SE(1), Bergenstal RM(2), Buse JB(3), Diamant M(4), Ferrannini E(5),Nauck M(6), Peters AL(7), Tsapas A(8), Wender R(9), Matthews DR(10). (1)Section of Endocrinology, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT [email protected] (2)International Diabetes Center at Park Nicollet, Minneapolis, MN. (3)Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, NC. (4)Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands. (5)Department of Medicine, University of Pisa School of Medicine, Pisa, Italy. (6)Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany. (7)Division of Endocrinology, Keck School of Medicine of the University of Southern California, Los Angeles, CA. (8)Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece. (9)American Cancer Society, Atlanta, GA Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA. (10)Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, U.K. National Institute for Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, U.K. Harris Manchester College, University of Oxford, Oxford, U.K. Comment in Diabetes Care. 2015 Aug;38(8):e125-6. Diabetes Care. 2015 Aug;38(8):e127. Diabetes Care. 2015 Sep;38(9):e143. Diabetes Care. 2015 Sep;38(9):e141-2. Diabetes Care. 2015 Aug;38(8):e128-9. Dipeptidyl-Peptidase IV In Continue reading >>

Management Of Hyperglycaemia In Type 2 Diabetes: The 2018 Consensus Report By Ada/easd Insights From One Of The Authors | Davies | British Journal Of Diabetes

Management Of Hyperglycaemia In Type 2 Diabetes: The 2018 Consensus Report By Ada/easd Insights From One Of The Authors | Davies | British Journal Of Diabetes

Management of hyperglycaemia in type 2 diabetes: the 2018 consensus report by ADA/EASD Insights from one of the authors type 2 diabetes, hyperglycaemia, consensus report, adult Davies MJ, DAlessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018 Oct 4. [Epub ahead of print]. Davies MJ, DAlessio DA, Fradkin J, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2018 Oct 5, [Epub ahead of print]. Inzucchi S, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a Position Statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2015;38:1409. Nathan D, Buse JB, Davidson MB, et al. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2006;29:196372. Inzucchi S, 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;55:157796. National Institute for Health and Care Excellence. Type 2 diabetes in adults: management. Guideline [28]. 2 December 2015, updated May 2017. National Institute for Health and Care Excellence. Type 2 diabetes in adults: manageme Continue reading >>

Demystifying

Demystifying "patient-centered" Care In Type 2 Diabetes: The Role Of Systematic Measurement

Demystifying "Patient-Centered" Care in Type 2 Diabetes: The Role of Systematic Measurement Evidence-Based Diabetes Management > March 2016 Published on: March 18, 2016 Demystifying "Patient-Centered" Care in Type 2 Diabetes: The Role of Systematic Measurement Questionnaires are noninvasive, inexpensive measures that can identify key elements of the patient perspective that are important for the achievement of better outcomes in diabetes care. Questionnaires are noninvasive, inexpensive measures that can identify key elements of the patient perspective that are important for the achievement of better outcomes in diabetes care. Over the last several decades, tremendous advancements have been made in understanding the microvascular and macrovascular pathophysiology of type 2 diabetes (T2D) and in understanding the roles of a healthy diet, physical activity, and pharmacotherapies in reducing morbidity and mortality associated with uncontrolled plasma glucose levels.1 Major public health initiatives have been implemented to support the prevention and management of T2D, and recent guidelines from the American Diabetes Association (ADA), the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics outline diabetes self-management education and support strategies that healthcare providers and accountable care organizations (ACOs) can use to promote self-care behaviors.2 These self-care behaviors include healthy eating, physical activity, daily monitoring activities, medication adherence, problem-solving skills, risk reduction strategies, and healthy coping strategies.2 These guidelines, along with the joint ADA/ European Association for the Study of Diabetes position statement on the treatment of T2D emphasize the importance of considering indivi Continue reading >>

Individualizing Treatment Of Hyperglycemia In Type 2 Diabetes

Individualizing Treatment Of Hyperglycemia In Type 2 Diabetes

From the University of Arizona College of Pharmacy and the University of Arizona College of Medicine-Tucson, Tucson, AZ. ABSTRACT • Objective: To summarize key issues relevant to managing hyperglycemia in patients with type 2 diabetes mellitus (T2DM) and review a strategy for initiating and intensifying therapy. • Methods: Review of the literature. • Results: The 6 most widely used pharmacologic treatment options for hyperglycemia in T2DM are metformin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, and insulin. Recent guidelines stress the importance of an individualized, patient-centered approach to managing hyperglycemia in T2DM, although sufficient guidance for nonspecialists on how to individualize treatment is often lacking. For patients with no contraindications, metformin should be recommended concurrent with lifestyle intervention at the time of diabetes diagnosis. Due to the progressive nature of T2DM, glycemic control on metformin monotherapy is likely to deteriorate over time, and there is no consensus as to what the second-line agent should be. A second agent should be selected based on glycemic goal and potential advantages and disadvantages of each agent for any given patient. If the patient progresses to the point where dual therapy does not provide adequate control, either a third non-insulin agent or insulin can be added. • Conclusion: Although research is increasingly focusing on what the ideal number and sequence of drugs should be when managing T2DM, investigating all possible combinations in diverse patient populations is not feasible. Physicians therefore must continue to rely on clinical judgment to determine how to apply trial data to the treatment o Continue reading >>

Management Of Hyperglycaemia In Type 2 Diabetes, 2018. A Consensus Report By The American Diabetes Association (ada) And The European Association For The Study Of Diabetes (easd)

Management Of Hyperglycaemia In Type 2 Diabetes, 2018. A Consensus Report By The American Diabetes Association (ada) And The European Association For The Study Of Diabetes (easd)

, Volume 61, Issue12 , pp 24612498 | Cite as Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) The American Diabetes Association and the European Association for the Study of Diabetes convened a panel to update the prior position statements, published in 2012 and 2015, on the management of type 2 diabetes in adults. A systematic evaluation of the literature since 2014 informed new recommendations. These include additional focus on lifestyle management and diabetes self-management education and support. For those with obesity, efforts targeting weight loss, including lifestyle, medication and surgical interventions, are recommended. With regards to medication management, for patients with clinical cardiovascular disease, a sodiumglucose cotransporter-2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP-1) receptor agonist with proven cardiovascular benefit is recommended. For patients with chronic kidney disease or clinical heart failure and atherosclerotic cardiovascular disease, an SGLT2 inhibitor with proven benefit is recommended. GLP-1 receptor agonists are generally recommended as the first injectable medication. Cardiovascular diseaseChronic kidney diseaseCostsGlucose-lowering therapyGuidelinesHeart failureHypoglycaemiaPatient-centred careType 2 diabetes mellitusWeight management Diabetes self-management education and support Empagliflozin, Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients Exenatide Study of Cardiovascular Event Lowering Liraglutide Effect and Action in Diabetes: Evaluation of of Cardiovascular Outcomes Results Trial to Evaluate Cardiovascular and Other Long-term Outcomes with Semaglutide in Subje Continue reading >>

An Update On Hyperglycemia In Type 2 Diabetes

An Update On Hyperglycemia In Type 2 Diabetes

An Update on Hyperglycemia in Type 2 Diabetes Clinical Director, Section of Endocrinology Director, Yale Affiliated Hospitals Program Silvio E. Inzucchi, MD, has indicated to Physicians Weekly that he has worked as a consultant for Merck, Boehringer Ingelheim, sanofi, and Novo Nordisk and as a paid speaker for AstraZeneca. He has also received grants/research aid from Takeda for study drug and placebo only. Clinical Director, Section of Endocrinology Director, Yale Affiliated Hospitals Program Silvio E. Inzucchi, MD, has indicated to Physicians Weekly that he has worked as a consultant for Merck, Boehringer Ingelheim, sanofi, and Novo Nordisk and as a paid speaker for AstraZeneca. He has also received grants/research aid from Takeda for study drug and placebo only. The American Diabetes Association and European Association for the Study of Diabetes have updated recommendations for managing hyperglycemia in type 2 diabetes. Patient-centered care and shared decision making continue to be important focus areas for clinicians. In 2012, the American Diabetes Association and the European Association for the Study of Diabetes published a position statement on the management of hyperglycemia in patients with type 2 diabetes. This was needed because of an increasing array of anti-hyperglycemic drugs and growing uncertainty regarding their proper selection and sequence, says Silvio E. Inzucchi, MD. However, the 2012 document was less prescriptive than prior consensus reports because of a paucity of comparative effectiveness research on long-term treatment outcomes with many of these medications. Recently, the American Diabetes Association and the European Association for the Study of Diabetes requested an update to the position statement that incorporates new data from recent cl Continue reading >>

Ada Updates Standards Of Medical Care For Patients With Diabetes Mellitus

Ada Updates Standards Of Medical Care For Patients With Diabetes Mellitus

Key Points for Practice • All adults should be tested for diabetes beginning at 45 years of age. • Overweight or obese patients with one or more risk factors for diabetes should be screened at any age. • Persons who use continuous glucose monitoring and insulin pumps should have continued access after 65 years of age. • Aspirin therapy should be considered for women with diabetes who are 50 years and older. • The addition of ezetimibe to statin therapy should be considered for eligible patients who can tolerate only a moderate-dose statin Ongoing patient self-management education and support are critical to preventing acute complications of diabetes mellitus and reducing the risk of long-term complications. The American Diabetes Association (ADA) recently updated its standards of care to provide the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Key changes in the 2016 update include new screening recommendations, clarification of diagnostic testing, and recommendations on the use of new technology for diabetes prevention, the use of continuous glucose monitoring devices, cardiovascular risk management, and screening for hyperlipidemia in children with type 1 diabetes. General recommendations for treatment of type 2 diabetes are shown in Figure 1. Antihyperglycemic therapy in type 2 diabetes: general recommendations. The order in the chart was determined by historical availability and the route of administration, with injectables to the right; it is not meant to denote any specific preference. Potential sequences of antihyperglycemic therapy for patients with type 2 diabetes are displayed, with the usual transition moving vertically from top to bottom, although horizontal movement within therapy stages is also Continue reading >>

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