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American Diabetes Association: Standards of Medical Care in Diabetes – 2016

9 Jan, 2016 | 15:13h | UTC

 

Access the complete 2016 ADA Guidelines at this link: Free full text

Diabetes Care. 2016 Jan;39 Suppl 1

 

SELECTED ASPECTS OF CARE IN TYPE 2 DIABETES

 

Criteria for screening for diabetes or prediabetes in asymptomatic adult:

– All patient > 45 years, regardless of weight;

– Test all adults who are overweight (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) AND have at least one of the following additional risk factors:

>>> physical inactivity

>>> first-degree relative with diabetes

>>> high-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)

>>> women who delivered a baby weighing >9 lb or were diagnosed with gestational diabetes

>>> hypertension

>>> history of CVD

>>> HDL cholesterol <35 mg/dL (0.90 mmol/L) and/or triglyceride >250 mg/dL (2.82 mmol/L)

>>> women with polycystic ovary syndrome

>>> A1C ≥5.7% (39 mmol/mol), impaired fasting glucose and/or impaired glucose tolerance on previous testing

>>> other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)

 

Diagnosis – any of the following criteria (no one test is preferred over another for diagnosis):

– Fasting plasma glucose (FPG) ≥126 mg/dL (7.0 mmol/L). *

– 2-h postprandial glucose (PG) ≥200 mg/dL (11.1 mmol/L) during an oral glucose tolerance test (OGTT) with a 75g glucose load. *

– A1C ≥6.5% (48 mmol/mol). *

– In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).

*in the absence of unequivocal hyperglycemia, results should be confirmed by repeating the SAME test.

 

Diagnosis of “Prediabetes” – Impaired Fasting Glucose (IFG) and/or Impaired Glucose Tolerance (IGT):

– IFG = FPG levels 100–125 mg/dL (5.6–6.9 mmol/L). WHO and other organizations define IFG cutoff at 110 mg/dL (6.1mmol/L).

– IGT = PG levels 140–199 mg/dL (7.8–11.0 mmol/L).

– A1C 5.7–6.4% (39–46 mmol/mol) identifies individuals with prediabetes.

 

Treatment – Glycemic targets:

– A reasonable A1C goal for many nonpregnant adults is <7% (53 mmol/mol).

– Providers might reasonably suggest more stringent A1C goals (such as <6.5% [48 mmol/mol]) for selected individual patients if this can be achieved without significant hypoglycemia or other adverse effects of treatment. Appropriate patients might include those with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expectancy, or no significant cardiovascular disease.

– Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the general goal is difficult to attain despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin.

 

Treatment – Hypertension:

– People with diabetes and hypertension should be treated to a systolic blood pressure goal of <140 mmHg and a diastolic blood pressure goal of <90 mmHg. Lower systolic (<130 mmHg) and diastolic (<80 mmHg) targets may be appropriate for younger patients, those with albuminuria, and for those with one or more additional atherosclerotic cardiovascular disease risk factors, if well tolerated.

 

Treatment – Lipid management:

– For patients with diabetes aged <40 years with additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity or high-intensity statin and lifestyle therapy.

– For patients with diabetes aged 40–75 years without additional atherosclerotic cardiovascular disease risk factors, consider using moderate-intensity statin and lifestyle therapy.

– For patients with diabetes aged 40–75 years with additional atherosclerotic cardiovascular disease risk factors, consider using high-intensity statin and lifestyle therapy.

 

Treatment – Aspirin:

– Consider aspirin therapy (75–162 mg/day) as a primary prevention strategy in those with type 1 or type 2 diabetes who are at increased cardiovascular risk (10-year risk >10%). This includes most men or women with diabetes aged ≥50 years who have at least one additional major risk factor (family history of premature atherosclerotic cardiovascular disease, hypertension, smoking, dyslipidemia, or albuminuria) and are not at increased risk of bleeding. (Grade C – Week Evidence)


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