Approaches to Glycemic Treatment in Diabetes: Difference between revisions

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__NOTOC__
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{{ADA guidelines}}
{{ADA guidelines}}
{{CMG}} {{AE}} {{SCh}}; {{MehdiP}}; {{TarekNafee}}
{{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===
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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>
|-
|-
| 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>
|-
|-
| 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>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Consider initiating insulin therapy (with or without additional agents) in patients with newly diagnosed type 2 diabetes and markedly symp- tomatic and/or elevated blood glu- cose levels or A1C. '([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>
| 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 max- imum 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>'''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>
|-
|-

Latest revision as of 20:49, 12 December 2016

2016 ADA Guideline Recommendations

Types of Diabetes Mellitus

Main Diabetes Page

Diabetes type I

Diabetes type II

Gestational Diabetes Mellitus

2016 ADA Standard of Medical Care Guideline Recommendations

Strategies for Improving Care

Classification and Diagnosis of Diabetes

Foundations of Care and Comprehensive Medical Evaluation

Diabetes Self-Management, Education, and Support
Nutritional Therapy

Prevention or Delay of Type II Diabetes

Glycemic Targets

Obesity Management for Treatment of Type II Diabetes

Approaches to Glycemic Treatment

Cardiovascular Disease and Risk Management

Hypertension and Blood Pressure Control
Lipid Management
Antiplatelet Agents
Coronary Heart Disease

Microvascular Complications and Foot Care

Diabetic Kidney Disease
Diabetic Retinopathy
Diabetic Neuropathy
Diabetic Footcare

Older Adults with Diabetes

Children and Adolescents with Diabetes

Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes
Microvascular Complications in Children and Adolescents with Diabetes

Management of Diabetes in Pregnancy

Diabetes Care in the Hospital Setting

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

  1. ↑ "care.diabetesjournals.org" (PDF).

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