Practice Guidelines

ADA Updates Standards of Medical Care for Patients with Diabetes Mellitus

 

Key Points for Practice

• All adults should be tested for diabetes beginning at 45 years of age.

• Overweight or obese patients with one or more risk factors for diabetes should be screened at any age.

• Persons who use continuous glucose monitoring and insulin pumps should have continued access after 65 years of age.

• Aspirin therapy should be considered for women with diabetes who are 50 years and older.

• The addition of ezetimibe to statin therapy should be considered for eligible patients who can tolerate only a moderate-dose statin

From the AFP Editors

Ongoing patient self-management education and support are critical to preventing acute complications of diabetes mellitus and reducing the risk of long-term complications. The American Diabetes Association (ADA) recently updated its standards of care to provide the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Key changes in the 2016 update include new screening recommendations, clarification of diagnostic testing, and recommendations on the use of new technology for diabetes prevention, the use of continuous glucose monitoring devices, cardiovascular risk management, and screening for hyperlipidemia in children with type 1 diabetes. General recommendations for treatment of type 2 diabetes are shown in Figure 1.

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Antihyperglycemic Therapy for Type 2 Diabetes Mellitus

Figure 1.

Antihyperglycemic therapy in type 2 diabetes: general recommendations. The order in the chart was determined by historical availability and the route of administration, with injectables to the right; it is not meant to denote any specific preference. Potential sequences of antihyperglycemic therapy for patients with type 2 diabetes are displayed, with the usual transition moving vertically from top to bottom, although horizontal movement within therapy stages is also possible, depending on the circumstances. (DPP-4 = dipeptidyl peptidase 4; GLP-1 = glucagon-like peptide 1; SGLT2 = sodium–glucose cotransporter 2; TZD = thiazolidinedione.)

Adapted with permission from Inzucchi SE, Bergenstal RM, Buse JM, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):145.

Antihyperglycemic Therapy for Type 2 Diabetes Mellitus


Figure 1.

Antihyperglycemic therapy in type 2 diabetes: general recommendations. The order in the chart was determined by historical availability and the route of administration, with injectables to the right; it is not meant to denote any specific preference. Potential sequences of antihyperglycemic therapy for patients with type 2 diabetes are displayed, with the usual transition moving vertically from top to bottom, although horizontal movement within therapy stages is also possible, depending on the circumstances. (DPP-4 = dipeptidyl peptidase 4; GLP-1 = glucagon-like peptide 1; SGLT2 = sodium–glucose cotransporter 2; TZD = thiazolidinedione.)

Adapted with permission from Inzucchi SE, Bergenstal RM, Buse JM, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):145.

Classification and Diagnosis

In the 2016 update, the ADA revised the order and discussion of diagnostic tests to make it clear that no one test is preferred over others. Diabetes may be diagnosed based on results of random plasma glucose testing (200 mg per dL [11.1 mmol per L] or greater), fasting plasma glucose testing (126 mg per dL [7 mmol per L] or greater after no caloric intake for at least eight hours), two-hour 75-g oral glucose tolerance testing (OGTT; 200 mg per dL or greater), or an A1C

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

 

 

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