Strategies for Improving Care: Difference between revisions
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==2016 ADA Standards of Medical Care in Diabetes Guidelines== | ==2016 ADA Standards of Medical Care in Diabetes Guidelines== | ||
{|class="wikitable" | {|class="wikitable" | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' A patient-centered communication style that incorporates patient preferences, assesses literacy and numeracy, and addresses cultural barriers to care should be used. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
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| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' | | bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Treatment decisions should be timely and based on evidence-based guidelines that are tailored to individual patient preferences, prognoses, and co- morbidities. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' | | bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' Care should be aligned with components of the Chronic Care Model to ensure productive interactions between a prepared proactive practice team and an informed activated patient. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' | | bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' When feasible, care systems should support team-based care, community involvement, patient registries, and decision support tools to meet patient needs. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
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|} | |||
===Food Insecurity=== | |||
{|class="wikitable" | |||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Providers should evaluate hyperglycemia and hypoglycemia in the context of food insecurity and propose solutions accordingly. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' Providers should recognize that homelessness, poor literacy, and poor numeracy often occur with food insecurity, and appropriate resources should be made avail- able for patients with diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | |||
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|} | |||
===Cognitive Dysfunction=== | |||
{|class="wikitable" | |||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Intensive glucose control is not ad- vised for the improvement of poor cognitive function in hyperglycemic individuals with type 2 diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''2.''' In individuals with poor cognitive function or severe hypoglycemia, glycemic therapy should be tailored to avoid significant hypoglycemia. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''3.''' In individuals with diabetes at high cardiovascular risk, the cardiovascular benefits of statin therapy outweigh the risk of cognitive dysfunction. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<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>''' | |} | ||
===Diabetes Care in Patients With HIV=== | |||
{|class="wikitable" | |||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Patients with HIV should be screened for diabetes and prediabetes with a fasting glucose level before starting antiretroviral therapy and 3 months after starting or changing it. If initial screening results are normal, check- ing fasting glucose each year is ad- vised. If prediabetes is detected, continue to measure levels every 3–6 months to monitor for pro- gression to diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | |||
|- | |- | ||
|} | |} | ||
== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}}{{WS}} | {{WH}}{{WS}} | ||
Revision as of 19:02, 6 December 2016
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2016 ADA Guideline Recommendations |
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Types of Diabetes Mellitus |
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2016 ADA Standard of Medical Care Guideline Recommendations |
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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]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]
2016 ADA Standards of Medical Care in Diabetes Guidelines
| "1. A patient-centered communication style that incorporates patient preferences, assesses literacy and numeracy, and addresses cultural barriers to care should be used. (Level of Evidence: B)" |
| "2. Treatment decisions should be timely and based on evidence-based guidelines that are tailored to individual patient preferences, prognoses, and co- morbidities. (Level of Evidence: B)" |
| "3. Care should be aligned with components of the Chronic Care Model to ensure productive interactions between a prepared proactive practice team and an informed activated patient. (Level of Evidence: A)" |
| "4. When feasible, care systems should support team-based care, community involvement, patient registries, and decision support tools to meet patient needs. (Level of Evidence: B)" |
Food Insecurity
| "1. Providers should evaluate hyperglycemia and hypoglycemia in the context of food insecurity and propose solutions accordingly. (Level of Evidence: A)" |
| "2. Providers should recognize that homelessness, poor literacy, and poor numeracy often occur with food insecurity, and appropriate resources should be made avail- able for patients with diabetes. (Level of Evidence: A)" |
Cognitive Dysfunction
| "1. Intensive glucose control is not ad- vised for the improvement of poor cognitive function in hyperglycemic individuals with type 2 diabetes. (Level of Evidence: B)" |
| "2. In individuals with poor cognitive function or severe hypoglycemia, glycemic therapy should be tailored to avoid significant hypoglycemia. (Level of Evidence: C)" |
| "3. In individuals with diabetes at high cardiovascular risk, the cardiovascular benefits of statin therapy outweigh the risk of cognitive dysfunction. (Level of Evidence: A)" |
| "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. (Level of Evidence: C)" |
Diabetes Care in Patients With HIV
| "1. Patients with HIV should be screened for diabetes and prediabetes with a fasting glucose level before starting antiretroviral therapy and 3 months after starting or changing it. If initial screening results are normal, check- ing fasting glucose each year is ad- vised. If prediabetes is detected, continue to measure levels every 3–6 months to monitor for pro- gression to diabetes. (Level of Evidence: E)" |