Practice Guidelines

Diabetes: ADA Releases Revised Position Statement on Standards of Medical Care

 

Am Fam Physician. 2018 Aug 1;98(3):187-188.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Testing for diabetes should be performed annually in persons who already have prediabetes, every three years in women who have had gestational diabetes, and starting at 45 years of age in all other persons.

• Patients with prediabetes should be referred to a behavioral lifestyle intervention program to encourage weight loss (7% of body weight) and 150 minutes of physical activity per week.

• In patients with atherosclerotic cardiovascular disease, treatment should start with lifestyle changes and metformin, with the addition of medications that decrease the risk of adverse cardiovascular events and cardiovascular mortality when dual therapy is needed.

From the AFP Editors

Because the evidence regarding medical care for persons with diabetes mellitus continues to evolve, the American Diabetes Association (ADA) annually updates its standards. In addition, starting in 2018, the ADA will also periodically update its guidance online if warranted. As with previous updates, this 2018 update is based on the most current evidence available regarding treatment of diabetes.

Diagnosis

Testing for prediabetes and type 2 diabetes in asymptomatic persons younger than 18 years should be performed in those who are overweight with at least one of the following factors: maternal history of diabetes or gestational diabetes, a first- or second-degree relative with type 2 diabetes, a high-risk ethnicity or race, or signs of insulin resistance or conditions connected to insulin resistance such as acanthosis nigricans, polycystic ovary syndrome, and dyslipidemia.

Testing for prediabetes or diabetes should be performed in asymptomatic adults who are overweight or obese with at least one of the following factors: a first-degree relative with diabetes, a high-risk ethnicity or race, history of cardiovascular disease, hypertension, a high-density lipoprotein level of less than 35 mg per dL (0.91 mmol per L) or a triglyceride level greater than 250 mg per dL (2.8 mmol per L), physical inactivity, polycystic ovary syndrome, or a condition connected with insulin resistance.

Testing should be performed annually in persons who already have prediabetes, every three years in women who have had gestational diabetes, and starting at 45 years of age in all other persons with repeat testing performed at least every three years if results are normal. Although not typically recommended because of inaccessibility of follow-up testing and care or lack of appropriate follow-up by patients with positive results, community screening outside of health care facilities can be considered in certain circumstances, assuming

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, Editor-in-Chief.

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

 

 

Copyright © 2018 by the American Academy of Family Physicians.
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