Sunday, May 8, 2016

2016 American Diabetes Association (ADA) Guideline for Primary Care of Diabetes

The American Diabetes Association (ADA) published the 2016 Standards of Medical Care in Diabetes (Standards) to provide clinicians, patients, researchers, payers, and other interested parties with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. The ADA Professional Practice Committee revised recommendations based on new evidence to include 8 key areas important to primary care providers, including:
Diagnosis – 
1. remains an A1c >6.5%, 
2. fasting plasma glucose >126; or 
3. an oral glucose tolerance 2 hr. result >200 mg/dL, or
4.  a random glucose >200mg/dL and classic symptoms of hyperglycemia.
English: Overview of the most significant poss...
English: Overview of the most significant possible symptoms of diabetes. See Wikipedia:Diabetes#Signs_and_symptoms for references. Model: Mikael Häggström. To discuss image, please see Template talk:Häggström diagrams (Photo credit: Wikipedia)
Glycemic targets - The HbA1c goal for most non-pregnant adults is less than 7%; more stringent HbA1c goals (such as <6.5%) may be recommended for patients without co-morbidities and who have a short duration of diabetes, and less stringent  A1c goals are appropriate for older patients with significant comorbid illness.
Hypoglycemia – severe or frequent hypoglycemia is an indication to modify treatment regimens.
Medical management – intervention should always include lifestyle modification with diet and exercise. If lifestyle modification is not sufficient to reach target A1c goals, then metformin should be added at or soon after diagnosis. If A1c is over target for longer than 3 months, then a second agent should be added. The second agent could be from the class of: sulfonylureas, thiazolidinediones, dipeptidyl peptidase-4 inhibitors, sodium–glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, or basal insulin.
Cardiovascular risk factor management - blood pressure treatment goal is <140/90 mm Hg, and an ACE or an ARB should be used as part of BP management. Statins are recommended for most persons with diabetes age 40 or older.
These recommendations highlight individualized care to manage the disease, prevent, or delay complications, and improve outcomes.
Citation: Chamberlain JJ, Rhinehart AS, Shaefer CF, Neuman A. Diagnosis and management of diabetes: Synopsis of the 2016 American Diabetes Association standards of medical care in diabetes. Ann Inter Med. 2016;164:542-552. doi:10.7326/M15-3016.


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