Foundations of Care and Comprehensive Medical Evaluation: Difference between revisions

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__NOTOC__
__NOTOC__
{{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>==
===PHYSICAL ACTIVITY===
===PHYSICAL ACTIVITY===
{|class="wikitable"
{|class="wikitable"
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Children with diabetes or predia- betes should be encouraged to en- gage in at least 60 min of physical activity each day. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Children with diabetes or prediabetes should be encouraged to en- gage in at least 60 min of physical activity each day. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Adults with diabetes should be ad- vised to perform at least 150 min/ week of moderate-intensity aerobic physical activity (50–70% of maxi- mum heart rate), spread over at least 3 days/week with no more than 2 consecutive days without exercise. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Adults with diabetes should be advised to perform at least 150 min/ week of moderate-intensity aerobic physical activity (50–70% of maxi- mum heart rate), spread over at least 3 days/week with no more than 2 consecutive days without exercise. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' All individuals, including those with diabetes, should be encouraged to reduce sedentary time, particularly by breaking up extended amounts of time (.90 min) spent sitting. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' All individuals, including those with diabetes, should be encouraged to reduce sedentary time, particularly by breaking up extended amounts of time (>90 min) spent sitting. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' In the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at least twice per week. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' In the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at least twice per week. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki>
Line 18: Line 18:
===SMOKING CESSATION: TOBACCO AND e-CIGARETTES===
===SMOKING CESSATION: TOBACCO AND e-CIGARETTES===
{|class="wikitable"
{|class="wikitable"
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Advise all patients not to use ciga- rettes, other tobacco products, or e-cigarettes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Advise all patients not to use cigarettes, other tobacco products, or e-cigarettes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.'''Include smoking cessation coun- seling and other forms of treat- ment as a routine component of diabetes care. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.'''Include smoking cessation coun- seling and other forms of treatment as a routine component of diabetes care. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>


|-
|-
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===IMMUNIZATION===
===IMMUNIZATION===
{|class="wikitable"
{|class="wikitable"
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Provide routine vaccinations for children and adults with diabetes as for the general population ac- cording to age-related recommendations ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Provide routine vaccinations for children and adults with diabetes as for the general population according to age-related recommendations ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.'''Administer hepatitis B vaccine to unvaccinated adults with diabetes who are aged 19–59 years. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.'''Administer hepatitis B vaccine to unvaccinated adults with diabetes who are aged 19–59 years. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Consider administering hepatitis B vaccine to unvaccinated adults with diabetes who are aged $60 years. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Consider administering hepatitis B vaccine to unvaccinated adults with diabetes who are aged ≥60 years. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki>
 
|-
|}
 
===PSYCHOSOCIAL ISSUES===
{|class="wikitable"
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1. '''The patient’s psychological and social situation should be addressed in the medical management of diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' If a second-generation antipsychotic medication is prescribed, changes in weight, glycemic control, and cho- lesterol levels should be carefully monitored and the treatment regi- men should be reassessed. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2. ''' Psychosocial screening and follow-up may include, but are not limited to, attitudes about the illness, expectations for medical management and outcomes, affect/ mood, general and diabetes-related quality of life, resources (financial, social, and emotional), and psychiatric history. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.'''Routinely screen for psychosocial problems such as depression, diabetes-related distress, anxiety, eating disorders, and cognitive impairment. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' Older adults (aged ≥65 years) with diabetes should be considered for evaluation of cognitive function and depression screening and treatment. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' Patients with comorbid diabetes and depression should receive a stepwise collaborative care approach for the management of depression ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki>
 
|-
|-
|}
|}


===PSYCHOSOCIAL ISSUES===
===COMPREHENSIVE MEDICAL EVALUATION===
{|class="wikitable"
{|class="wikitable"
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1. '''The patient’s psychological and social situation should be ad- dressed in the medical manage- ment of diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
A complete medical evaluation should be performed at the initial visit to
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1. '''Confirm the diagnosis and classify
diabetes ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2. ''' Psychosocial screening and follow- up may include, but are not lim- ited to, attitudes about the illness, expectations for medical man- agement and outcomes, affect/ mood, general and diabetes-related quality of life, resources (financial, social, and emotional), and psychiatric history. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2. '''Detect diabetes complications and
potential comorbid conditions. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.'''Routinely screen for psychoso- cial problems such as depression, diabetes-related distress, anxiety, eating disorders, and cognitive impairment. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.'''Review previous treatment and risk factor control in patients
with established diabetes ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' Older adults (aged $65 years) with diabetes should be consid- ered for evaluation of cognitive function and depression screening and treatment. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' Begin patient engagement in the formulation of a care management plan. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' Patients with comorbid diabetes and depression should receive a stepwise collaborative care ap- proach for the management of depression ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki>
| bgcolor="Seashell"|<nowiki>"</nowiki>'''5.''' Develop a plan for continuing care ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki>


|-
|-
|}
|}

Latest revision as of 20:50, 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]

PHYSICAL ACTIVITY

"1. Children with diabetes or prediabetes should be encouraged to en- gage in at least 60 min of physical activity each day. (Level of Evidence: B)"
"2. Adults with diabetes should be advised to perform at least 150 min/ week of moderate-intensity aerobic physical activity (50–70% of maxi- mum heart rate), spread over at least 3 days/week with no more than 2 consecutive days without exercise. (Level of Evidence: A)"
"3. All individuals, including those with diabetes, should be encouraged to reduce sedentary time, particularly by breaking up extended amounts of time (>90 min) spent sitting. (Level of Evidence: B)"
"4. In the absence of contraindications, adults with type 2 diabetes should be encouraged to perform resistance training at least twice per week. (Level of Evidence: A)"

SMOKING CESSATION: TOBACCO AND e-CIGARETTES

"1. Advise all patients not to use cigarettes, other tobacco products, or e-cigarettes. (Level of Evidence: A)"
"2.Include smoking cessation coun- seling and other forms of treatment as a routine component of diabetes care. (Level of Evidence: B)"

IMMUNIZATION

"1. Provide routine vaccinations for children and adults with diabetes as for the general population according to age-related recommendations (Level of Evidence: C)"
"2.Administer hepatitis B vaccine to unvaccinated adults with diabetes who are aged 19–59 years. (Level of Evidence: C)"
"3. Consider administering hepatitis B vaccine to unvaccinated adults with diabetes who are aged ≥60 years. (Level of Evidence: C)"

PSYCHOSOCIAL ISSUES

"1. The patient’s psychological and social situation should be addressed in the medical management of diabetes. (Level of Evidence: B)"
"2. Psychosocial screening and follow-up may include, but are not limited to, attitudes about the illness, expectations for medical management and outcomes, affect/ mood, general and diabetes-related quality of life, resources (financial, social, and emotional), and psychiatric history. (Level of Evidence: E)"
"3.Routinely screen for psychosocial problems such as depression, diabetes-related distress, anxiety, eating disorders, and cognitive impairment. (Level of Evidence: B)"
"4. Older adults (aged ≥65 years) with diabetes should be considered for evaluation of cognitive function and depression screening and treatment. (Level of Evidence: B)"
"5. Patients with comorbid diabetes and depression should receive a stepwise collaborative care approach for the management of depression (Level of Evidence: A)"

COMPREHENSIVE MEDICAL EVALUATION

A complete medical evaluation should be performed at the initial visit to
"1. Confirm the diagnosis and classify

diabetes (Level of Evidence: B)"

"2. Detect diabetes complications and

potential comorbid conditions. (Level of Evidence: E)"

"3.Review previous treatment and risk factor control in patients

with established diabetes (Level of Evidence: E)"

"4. Begin patient engagement in the formulation of a care management plan. (Level of Evidence: B)"
"5. Develop a plan for continuing care (Level of Evidence: B)"
  1. ↑ "care.diabetesjournals.org" (PDF).
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