Strategies for Improving Care: Difference between revisions
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{{ADA guidelines}} | {{ADA guidelines}} | ||
{{CMG}} {{AE}} {{SCh}}; {{TarekNafee}} | {{CMG}} {{AE}} {{SCh}}; {{TarekNafee}} | ||
==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>== | ==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>== | ||
{|class="wikitable" | {|class="wikitable" | ||
| 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> | | 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> | ||
|- | |- | ||
| 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 | | 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 [[Comorbidity|comorbidities]]. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| 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>'''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.''' 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> | | 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=== | ===Food Insecurity=== | ||
{|class="wikitable" | {|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>'''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 available for patients with diabetes. ''([[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 available for [[patients]] with [[diabetes]]. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
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===Cognitive Dysfunction=== | ===Cognitive Dysfunction=== | ||
{|class="wikitable" | {|class="wikitable" | ||
| bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' Intensive glucose control is not advised 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>'''1.''' Intensive [[glucose]] control is not advised for the improvement of poor cognitive function in [[hyperglycemia|hyperglycemic]] individuals with [[diabetes mellitus type 2|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>'''2.''' In individuals with poor cognitive function or severe [[hypoglycemia]], [[blood sugar|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>'''3.''' In individuals with [[diabetes]] at high [[Circulatory system|cardiovascular]] risk, the [[Circulatory system|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 cholesterol levels should be carefully monitored and the treatment regimen should be reassessed. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''4.''' If a second-generation [[Antipsychotics|antipsychotic medication]] is prescribed, changes in weight, [[blood sugar|glycemic control]], and [[cholesterol]] levels should be carefully monitored and the [[treatment]] regimen should be reassessed. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
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===Diabetes Care in Patients With HIV=== | ===Diabetes Care in Patients With HIV=== | ||
{|class="wikitable" | {|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, checking fasting glucose each year is advised. If prediabetes is detected, continue to measure levels every 3–6 months to monitor for progression to diabetes. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | | bgcolor="Seashell"|<nowiki>"</nowiki>'''1.''' [[patient|Patients]] with [[Human Immunodeficiency Virus (HIV)|HIV]] should be [[Screening (medicine)|screened]] for [[diabetes]] and [[prediabetes]] with a fasting [[glucose]] level before starting [[HIV AIDS medical therapy|antiretroviral therapy]] and 3 months after starting or changing it. If initial [[Screening (medicine)|screening]] results are normal, checking fasting [[glucose]] each year is advised. If [[prediabetes]] is detected, continue to measure levels every 3–6 months to monitor for progression to [[diabetes]]. ''([[American Diabetes Association#Evidence Grading System|Level of Evidence: E]])''<nowiki>"</nowiki> | ||
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Revision as of 11:59, 21 September 2020
|
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]; Tarek Nafee, M.D. [3]
2016 ADA Standards of Medical Care in Diabetes Guidelines[1]
| "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 comorbidities. (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 available for patients with diabetes. (Level of Evidence: A)" |
Cognitive Dysfunction
| "1. Intensive glucose control is not advised 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 cholesterol levels should be carefully monitored and the treatment regimen 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, checking fasting glucose each year is advised. If prediabetes is detected, continue to measure levels every 3–6 months to monitor for progression to diabetes. (Level of Evidence: E)" |
References
- ↑ "care.diabetesjournals.org" (PDF).