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diagnosed with diabetes or are at-risk of developing diabetes. This document provides population management tools and approaches to proactively monitor and manage diabetes, which includes evidence-based treatment protocol s and approaches using clinical practice data to drive improvement.
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- Balancing Risks and Benefits for Personalized Goals
- Improving Glycemic Management
- Shared decision making in type 2 diabetes
- Diabetes Self-Management Education and Support (DSMES)
- Empathic patient-centered care
- Clinical Inertia
- Considerations
More Stringent Control No hypoglycemia Less complexity/polypharmacy Lifestyle or metformin only Short disease duration Long life expectancy No CVD Less Stringent Control History of severe hypoglycemia High burden of therapy Longer disease duration Limited life expectancy Extensive co-morbidity CVD
Focus on treatments for glycemic control Behavioral approaches Medications Metabolic surgery Address increasing complexity of patient centered therapeutic decisions in the context of expanding therapeutic options and new information on benefits and risks
SDM can improve decision quality patient knowledge patient risk perception Ethical imperative for support of patients’ autonomy
Is available to patients at critical times Individualized to the needs of the person, including language and culture Structured theory-driven written curriculum with supporting materials Delivered in group or individual settings by trained educators Promote healthy eating, physical activity, good medication-taking behavior, and increase self-effica...
Patients with diabetes often live with multiple chronic conditions Providers & health care systems should prioritize the delivery of empathic, individualized patient-centered care To determine what is the best management option for each patient, consider each individual’s personal, social and biomedical context, his/her values, reasons he/she value...
Clinical inertia: failure of healthcare providers to initiate or intensify therapy when indicated, due to: overestimation of care provided use of “soft” reasons to avoid intensification of therapy lack of education, training, and practice organization aimed at achieving therapeutic goals
ASCVD is defined differently across trials Established CVD (e.g. MI, stroke, revascularization procedure) Very high cardiovascular risk Each cardiovascular outcomes trial, while large, is a single experiment It is not always clear whether differences in trial findings within a drug class are related to trial design or to true differences in the ind...
This updated guideline provides recommendations for the care and management of people with or at risk for diabetes mellitus at every stage, including prevention, diagnosis, and treatment.
- 15.1 Perform an A1C test on all patients with diabetes or hyperglycemia (blood glucose >140 mg/dL [7.8 mmol/L]) admitted to the hospital if not performed in the prior 3 months.
- 15.2 Insulin should be administered using validated written or computerized protocols that allow for predefined adjustments in the insulin dosage based on glycemic fluctuations.
- 15.3 When caring for hospitalized patients with diabetes, consult with a specialized diabetes or glucose management team when possible. C.
- 15.4 Insulin therapy should be initiated for treatment of persistent hyperglycemia starting at a threshold ≥180 mg/dL (10.0 mmol/L). Once insulin therapy is started, a target glucose range of 140–180 mg/dL (7.8–10.0 mmol/L) is recommended for the majority of critically ill and noncritically ill patients.
The general target for glucose control in T2D should be less than 7% (53 mmol/mol). Lower HbA1c targets are desirable or at least should be considered, as long as hypoglycemia and weight gain can be avoided using appropriate treatments. Values of HbA1c above 8% (64 mmol/mol) are generally unacceptable.
Imposing glucose targets that are not achievable in high-risk patients may have detrimental outcomes. Likewise, the inadequate treatment of recent-onset diabetes may promote further beta-cell failure and place the patient at risk for both microvascular and macrovascular complications.
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ACP Guideline: Oral pharmacologic treatment of diabetes (Endorsed by the AAFP) Guiding Principles for the Care of People With or At-Risk of Diabetes (Supported by the AAFP)
