Professional Documents
Culture Documents
Standardofcare2017fulldeckfinal 0 PDF
Standardofcare2017fulldeckfinal 0 PDF
in Diabetes - 2017
This slide deck contains content created, reviewed, and
approved by the American Diabetes Association. You are
free to use the slides in presentations without further
permission as long as the slide content is not altered in
any way and appropriate attribution is made to the
American Diabetes Association (the Association name and
logo on the slides constitutes appropriate
attribution). Permission is required from the
Association for any commercial use or for
reproduction in any print materials (contact
permissions@diabetes.org)
Standards of Care
• Funded out Association’s general revenues and
does not use industry support.
• Slides correspond with sections within the
Standards of Medical Care in Diabetes - 2017.
• Reviewed and approved by the Association’s
Board of Directors.
Process
• ADA’s Professional Practice Committee (PPC)
conducts annual review & revision.
• Searched Medline for human studies related to each
subsection and published since January 1, 2016.
• Recommendations revised per new evidence, for
clarity, or to better match text to strength of
evidence.
Professional.diabetes.org/SOC
Professional Practice Committee
Members of the PPC ADA Staff
• William H. Herman, MD, MPH (Co-Chair) • Erika Gebel Berg, PhD
• Rita R. Kalyani, MD, MHS, FACP (Co-Chair) • Sheri Colberg-Ochs, PhD
• Andrea L. Cherrington, MD, MPH • Alicia H. McAuliffe-Fogarty, PhD, CPsycol
• Donald R. Coustan, MD • Sacha Uelmen, RDN, CDE
• Ian de Boer, MD, MS • Robert E. Ratner, MD, FACP, FACE
• Robert James Dudl, MD
• Hope Feldman, CRNP, FNP-BC
• Hermes J. Florez, MD, PhD, MPH
• Suneil Koliwad, MD, PhD
• Melinda Maryniuk, MEd, RD, CDE
• Joshua J. Neumiller, PharmD, CDE, FASCP
• Joseph Wolfsdorf, MB, BCh
Evidence Grading System
1.
Promoting Health and Reducing
Disparities in Populations
Key Recommendations
• Treatment decisions should be timely and based
on evidence-based guidelines that are tailored to
patient preferences, prognoses, and
comorbidities. B
• Providers should consider the burden of
treatment and self-efficacy of patients when
recommending treatments. E
www.BetterDiabetesCare.nih.gov
www.DiabetesTrialNet.org
A1C 5.7–6.4%
* For all three tests, risk is continuous, extending below the lower limit of a
range and becoming disproportionately greater at higher ends of the range.
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2017; 40 (Suppl. 1): S11-S24
Recommendations: Testing for Type 2 Diabetes
• Screening for type 2 diabetes with an informal
assessment of risk factors or validated tools should be
considered in asymptomatic adults. B
• Consider testing in asymptomatic adults of any age with
BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans who
have 1 or more add’l dm risk factors. B
• For all patients, testing should begin at age 45 years. B
• If tests are normal, repeat testing carried out at a
minimum of 3-year intervals is reasonable. C
www.diabetes.org/are-you-at-risk
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2017; 40 (Suppl. 1): S11-S24
Criteria for Testing for T2DM in Children & Adolescents
• Overweight plus any 2 :
– Family history of type 2 diabetes in 1st or 2nd degree relative
– Race/ethnicity
– Signs of insulin resistance or conditions associated with
insulin resistance
– Maternal history of diabetes or GDM
• Age of initiation 10 years or at onset of puberty
• Frequency: every 3 years
• Test with FPG, OGTT, or A1C
American Diabetes Association Standards of Medical Care in Diabetes.
Classification and diagnosis of diabetes. Diabetes Care 2017; 40 (Suppl. 1): S11-S24
Recommendations: Detection and Diagnosis of GDM
Medical history:
• Age and characteristics of onset of diabetes
• Eating patterns, nutritional status, weight history, sleep
behaviors, physical activity habits, nutrition education
• Presence of common comorbidities and dental disease
• Screen for psychosocial problems and other barriers to
self-management
• History of tobacco use, alcohol consumption, and
substance use
American Diabetes Association Standards of Medical Care in Diabetes. Comprehensive Medical
Evaluation and Assessment of Comorbidities. Diabetes Care 2017; 40 (Suppl. 1): S25-S32
Components of the Comprehensive Diabetes Evaluation (2)
Medical History (2):
• Diabetes education, self-management, and support
history & needs
• Previous treatment regimens and response to therapy
(A1C records)
• Results of glucose monitoring and patient’s use of data
• DKA frequency, severity, and cause
• Hypoglycemia episodes, awareness, frequency & causes
• Assess medication-taking behaviors/barriers to adherence
American Diabetes Association Standards of Medical Care in Diabetes. Comprehensive Medical
Evaluation and Assessment of Comorbidities. Diabetes Care 2017; 40 (Suppl. 1): S25-S32
Components of the Comprehensive Diabetes Evaluation (3)
Physical Examination:
• Height, weight, and BMI; growth and pubertal development
in children and adolescents
• Blood pressure determination, including orthostatic
measurements when indicated
• Fundoscopic examination
• Thyroid palpation
• Skin examination
• Comprehensive foot examination
American Diabetes Association Standards of Medical Care in Diabetes. Comprehensive Medical
Evaluation and Assessment of Comorbidities. Diabetes Care 2017; 40 (Suppl. 1): S25-S32
Components of the Comprehensive Diabetes Evaluation (5)
Laboratory Evaluation
• A1C, if results not available within past 3 months
• If not performed/available within past year:
– Fasting lipid profile
– Liver function tests
– Spot urinary albumin-to-creatinine ratio
– Serum creatinine and eGFR
– Thyroid-stimulating hormone in patients with type 1 diabetes
A1C <7.0%*
(<53 mmol/mol)
Preprandial capillary 80–130 mg/dL*
plasma glucose (4.4–7.2 mmol/L)
Peak postprandial capillary plasma <180 mg/dL*
glucose† (<10.0 mmol/L)
Pharmacotherapy ┼ ┼ ┼ ┼
Metabolic surgery ┼ ┼ ┼
* Asian-American individuals
┼ Treatment may be indicated for selected, motivated patients.
American Diabetes Association Standards of Medical Care in Diabetes. Obesity management
for the treatment of type 2 diabetes. Diabetes Care 2017; 40 (Suppl. 1): S57-S63
Recommendations: Diet, physical activity & behavioral therapy
Systolic Targets:
• People with diabetes and hypertension should be
treated to a systolic blood pressure goal of <140
mmHg. A
• Lower systolic targets, such as <130 mmHg,
may be appropriate for certain individuals at
high risk of CVD, if they can be achieved
without undue treatment burden. C
American Diabetes Association Standards of Medical Care in Diabetes.
Cardiovascular disease and risk management. Diabetes Care 2017; 40 (Suppl. 1): S75-S87
Recommendations: Hypertension/ Blood Pressure Control (3)
Diastolic Targets:
• Patients with diabetes should be treated to a
diastolic blood pressure <90 mmHg. A
• Lower diastolic targets, such as <80 mmHg,
may be appropriate for certain individuals at
high risk for CVD if they can be achieved
without undue treatment burden. C
Pregnant patients:
• In pregnant patients with diabetes and chronic
hypertension, blood pressure targets of 120–
160/80–105 mmHg are suggested in the interest
of optimizing long-term maternal health and
minimizing impaired fetal growth. E
Screening
• In asymptomatic patients, routine screening for CAD
isn’t recommended & doesn’t improve outcomes
provided ASCVD risk factors are treated. A
• Consider investigations for CAD with:
– Atypical cardiac symptoms (e.g. unexplained dyspnea, chest discomfort)
– Signs or symptoms of associated vascular disease incl. carotid bruits,
transient ischemic attack, stroke, claudication or PAD
– EKG abnormalities (e.g. Q waves) E
• Full version
• Abridged version for PCPs
• Free app
• Pocket cards with key figures
• Free webcast for continuing
education credit
Professional.Diabetes.org/SOC
Professional Education
• Live programs
• Online self-assessment
programs
• Online webcasts
Professional.Diabetes.org/CE
Diabetes Self-Management Education
• Find a recognized Diabetes Self-
Management program
• Become a recognized DSME
program
• Tools and resources for DSME
programs
• Online education documentation
tools
Professional.Diabetes.org/ERP
Professional Membership
• Journals
• Meeting, book and journal discounts
• Career center
• Quarterly member newsletter
Professional.Diabetes.org/membership
Thank you