Approaches to Glycemic Treatment in Diabetes: Difference between revisions
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{{ADA guidelines}} | {{ADA guidelines}} | ||
{{CMG}} {{AE}} {{SCh | {{CMG}} {{AE}} {{SCh}}; {{TarekNafee}} | ||
==2016 ADA Standards of Medical Care in Diabetes Guidelines== | ==2016 ADA Standards of Medical Care in Diabetes Guidelines<ref name="urlcare.diabetesjournals.org">{{cite web |url=http://care.diabetesjournals.org/content/suppl/2015/12/21/39.Supplement_1.DC2/2016-Standards-of-Care.pdf |title=care.diabetesjournals.org |format= |work= |accessdate=}}</ref>== | ||
===PHARMACOLOGICAL THERAPY FOR TYPE 1 DIABETES=== | ===PHARMACOLOGICAL THERAPY FOR TYPE 1 DIABETES=== | ||
{|class="wikitable" | {|class="wikitable" | ||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Consider educating individuals with type 1 diabetes on matching prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Consider educating individuals with type 1 diabetes on matching prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Most individuals with type 1 diabetes should use insulin analogs to reduce | | bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Most individuals with type 1 diabetes should use insulin analogs to reduce hypoglycemia risk. '([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
hypoglycemia risk. '([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | |||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' Individuals who have been successfully using continuous subcutaneous insulin | | bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' Individuals who have been successfully using continuous subcutaneous insulin | ||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Metformin, if not contraindicated and if tolerated, is the preferred initial pharmacological agent for type 2 diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Metformin, if not contraindicated and if tolerated, is the preferred initial pharmacological agent for type 2 diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Consider initiating insulin therapy (with or without additional agents) in patients with newly diagnosed type 2 diabetes and markedly | | bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Consider initiating insulin therapy (with or without additional agents) in patients with newly diagnosed type 2 diabetes and markedly symptomatic and/or elevated blood glucose levels or A1C. '([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' If noninsulin monotherapy at | | bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' If noninsulin monotherapy at maximum tolerated dose does not achieve or maintain the A1C target over 3 months, then add a second oral agent, a glucagon-like peptide 1 receptor agonist, or basal insulin. '([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' A patient-centered approach should be used to guide the choice of pharmacological agents. Con- siderations include efficacy, cost, potential side effects, weight, co- morbidities, hypoglycemia risk, and patient preferences. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' A patient-centered approach should be used to guide the choice of pharmacological agents. Con- siderations include efficacy, cost, potential side effects, weight, co- morbidities, hypoglycemia risk, and patient preferences. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
|- | |||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' For patients with type 2 diabetes who are not achieving glycemic goals, insulin therapy should not be delayed. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' For patients with type 2 diabetes who are not achieving glycemic goals, insulin therapy should not be delayed. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
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== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}}{{WS}} | {{WH}}{{WS}} | ||
Latest revision as of 20:49, 12 December 2016
|
2016 ADA Guideline Recommendations |
|
Types of Diabetes Mellitus |
|---|
|
2016 ADA Standard of Medical Care Guideline Recommendations |
|
Cardiovascular Disease and Risk Management |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Tarek Nafee, M.D. [3]
2016 ADA Standards of Medical Care in Diabetes Guidelines[1]
PHARMACOLOGICAL THERAPY FOR TYPE 1 DIABETES
| "1. Most people with type 1 diabetes should be treated with multiple-dose insulin injections (three to four injections per day of basal and prandial insulin) or continuous subcutaneous insulin infusion. (Level of Evidence: A)" |
| "2. Consider educating individuals with type 1 diabetes on matching prandial insulin dose to carbohydrate intake, premeal blood glucose, and anticipated activity. (Level of Evidence: E)" |
| "3. Most individuals with type 1 diabetes should use insulin analogs to reduce hypoglycemia risk. '(Level of Evidence: A)" |
| "4. Individuals who have been successfully using continuous subcutaneous insulin
infusion should have continued access after they turn 65 years of age. (Level of Evidence: E)" |
PHARMACOLOGICAL THERAPY FOR TYPE 2 DIABETES
| "1. Metformin, if not contraindicated and if tolerated, is the preferred initial pharmacological agent for type 2 diabetes. (Level of Evidence: A)" |
| "2. Consider initiating insulin therapy (with or without additional agents) in patients with newly diagnosed type 2 diabetes and markedly symptomatic and/or elevated blood glucose levels or A1C. '(Level of Evidence: E)" |
| "3. If noninsulin monotherapy at maximum tolerated dose does not achieve or maintain the A1C target over 3 months, then add a second oral agent, a glucagon-like peptide 1 receptor agonist, or basal insulin. '(Level of Evidence: A)" |
| "4. A patient-centered approach should be used to guide the choice of pharmacological agents. Con- siderations include efficacy, cost, potential side effects, weight, co- morbidities, hypoglycemia risk, and patient preferences. (Level of Evidence: E)" |
| "5. For patients with type 2 diabetes who are not achieving glycemic goals, insulin therapy should not be delayed. (Level of Evidence: B)" |
References
- ↑ "care.diabetesjournals.org" (PDF).