Follow-up of three large studies of lifestyle intervention for diabetes prevention has shown sustained reduction in the rate of conversion to type 2 diabetes: 39% reduction at 30 years in the Da Qing Diabetes Prevention Study, 43% reduction at 7 years in the Finnish Diabetes Prevention Study, and 34% reduction at 10 years and 27% reduction at 15 years in the U.S. Diabetes Prevention Program Outcomes Study. E, 6.15 Insulin-treated patients with hypoglycemia unawareness, one level 3 hypoglycemic event, or a pattern of unexplained level 2 hypoglycemia should be advised to raise their glycemic targets to strictly avoid hypoglycemia for at least several weeks in order to partially reverse hypoglycemia unawareness and reduce risk of future episodes. Reprinted from Davies MJ, D’Alessio DA, Fradkin J, et al. 14.15 Metformin, when used to treat polycystic ovary syndrome and induce ovulation, should be discontinued by the end of the first trimester. A, 10.11 Multiple-drug therapy is generally required to achieve blood pressure targets. The safety and efficacy of noninsulin glucose-lowering therapies in the hospital setting is an area of active research. Newer forms of diabetes technology include hybrid devices that both deliver insulin and monitor glucose levels and software that provides diabetes self-management support. Glycemic Targets,” “13. NICE type 2 diabetes in children guideline. Recomendações ADA 2020 Guia de Bolso Insulinoterapia NOC Diabetes T2 NOC Insulinoterapia ADA EASD 2019 Quadros resumo Guia de Bolso de Insulinoterapia na Diabetes tipo 2 Download PDF do Guia de Bolso de Insulinoterapia na Diabetes tipo 2 … A Other oral and noninsulin injectable glucose-lowering medications lack long-term safety data. E, 14.27 Postpartum care should include psychosocial assessment and support for self-care. Population health is defined as “the health outcomes of a group of individuals, including the distribution of health outcomes within the group”; these outcomes can be measured in terms of health outcomes (mortality, morbidity, health, and functional status), disease burden (incidence and prevalence), and behavioral and metabolic factors (exercise, diet, A1C, etc.). Metformin is the first-line agent for older adults with type 2 diabetes. C. Initial orders should state the type of diabetes. Drug-specific and patient factors to consider when selecting antihyperglycemic treatment in adults with type 2 diabetes, 9.4 Metformin is the preferred initial pharmacologic agent for the treatment of type 2 diabetes. B, 5.44 Annually screen people who are prescribed atypical antipsychotic medications for prediabetes or diabetes. Medication use in DM2. Readers may use this work as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. © 2021 by the American Diabetes Association. E, 8.18 Long-term lifestyle support and routine monitoring of micronutrient and nutritional status must be provided to patients after surgery, according to guidelines for postoperative management of metabolic surgery by national and international professional societies. DSME and ongoing support are vital components of diabetes care for older adults and their caregivers. A. 5.24 Children and adolescents with type 1 or type 2 diabetes or prediabetes should engage in 60 min/day or more of moderate- or vigorous-intensity aerobic activity, with vigorous muscle-strengthening and bone-strengthening activities at least 3 days/week. C, 6.11 In patients taking medication that can lead to hypoglycemia, investigate, screen, and assess risk for or occurrence of unrecognized hypoglycemia, considering that patients may have hypoglycemia unawareness. C, 10.28 Statin therapy is contraindicated in pregnancy. 2020 Jan. 43 (Suppl 1):S4-S6.. World Health Organization. Comprehensive Medical Evaluation and Assessment of Comorbidities”, “Physical Activity/Exercise and Diabetes”, “Psychosocial Care for People With Diabetes”, “14. C, 5.28 Flexibility training and balance training are recommended 2–3 times/week for older adults with diabetes. If using two separate test samples, it is recommended that the second test, which may either be a repeat of the initial test or a different test, be performed without delay. E. Among hospitalized patients, both hyperglycemia and hypoglycemia are associated with adverse outcomes, including death. Modest and sustained weight loss has been shown to improve glycemic control and reduce the need for glucose-lowering medications. E, 6.2 Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. Unless there is a clear clinical diagnosis based on overt signs of hyperglycemia, diagnosis requires two abnormal test results from the same sample or in two separate test samples. Two clinical trials studied the combinations of ACE inhibitors and ARBs and found no benefits on CVD or CKD and a higher rate of adverse events (hyperkalemia and/or acute kidney injury) with the combination. A meta-analysis of 13 randomized statin trials showed an odds ratio of 1.09 for a new diagnosis of diabetes, so that (on average) treatment of 255 patients with statins for 4 years resulted in one additional case of diabetes while simultaneously preventing 5.4 vascular events among those 255 patients. Diabetes Care 2018;41:2669–2701. The needs of older adults with diabetes and their caregivers should be evaluated to construct a tailored care plan. SDoH are defined as the economic, environmental, political, and social conditions in which people live and are responsible for a major part of health inequality worldwide. E, 9.8 A patient-centered approach should be used to guide the choice of pharmacologic agents. 13.59 A reasonable A1C target for most children and adolescents with type 2 diabetes treated with oral agents alone is <7% (53 mmol/mol). Description: ADA 2020 Presentation Slides | REDUCE-IT DIABETES. B, 4.13 Adult patients with type 1 diabetes should be screened for celiac disease in the presence of gastrointestinal symptoms, signs, or laboratory manifestations suggestive of celiac disease. A—Clear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered, B—Supportive evidence from well-conducted cohort studies, C—Supportive evidence from poorly controlled or uncontrolled studies, E—Expert consensus or clinical experience. Providers caring for older adults with diabetes must take this heterogeneity into consideration when setting and prioritizing treatment goals. B. E, 10.26 In adults with diabetes aged >75 years already on statin therapy, it is reasonable to continue statin treatment. E, 7.2 Most patients using intensive insulin regimens (multiple daily injection [MDI] or continuous subcutaneous insulin infusion [CSII; insulin pump therapy]) should be encouraged to assess glucose levels using SMBG (and/or CGM) prior to meals and snacks, at bedtime, prior to exercise, when they suspect low blood glucose, after treating low blood glucose until they are normoglycemic, and prior to and while performing critical tasks such as driving. Table 6.3 summarizes glycemic recommendations for many nonpregnant adults. Before people develop type 2 diabetes, they almost always have "prediabetes"—blood sugar levels that are higher than normal but not yet high enough to be diagnosed as diabetes. Readers may link to the version of record of this work on professional.diabetes.org/standards, but ADA permission is required to post this work on any third-party website or platform. ADA and EASD Cosensus Report (2019) B, 1.2 Align approaches to diabetes management with the Chronic Care Model (CCM). The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge. A, 5.30 After identification of tobacco or e-cigarette use, include smoking cessation counseling and other forms of treatment as a routine component of diabetes care. To make CGM metrics more actionable, standardized reports with visual cues such as the AGP (Figure 6.1) are recommended and may help patients and providers interpret the data and use it to guide treatment decisions. A, 10.10 Treatment for hypertension should include drug classes demonstrated to reduce CV events in patients with diabetes (ACE inhibitors, angiotensin receptor blockers [ARBs], thiazide-like diuretics, or dihydropyridine calcium channel blockers [CCBs]). 6.1 Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). A protocol should exist for these situations. Clinical information systems (using registries that can provide patient-specific and population-based support to the care team), 5. Treatments for each patient should be individualized. Models such as these are potentially important and, once validated for general use, could provide a valuable tool to reduce rates of hypoglycemia in hospitalized patients. Shorter durations (minimum 75 min/week) of vigorous-intensity or interval training may be sufficient for younger and more physically fit individuals. B, 11.9 An ACE inhibitor or ARB is not recommended for the primary prevention of CKD in patients with diabetes who have normal blood pressure, normal UACR (<30 mg/g Cr), and normal eGFR. The diet should not be high in saturated fat. The DPP trial demonstrated that an intensive lifestyle intervention could reduce the incidence of type 2 diabetes by 58% over 3 years. In the critical care setting, continuous intravenous insulin infusion is the best method for achieving glycemic targets. The patient’s specific needs and goals should dictate SMBG frequency and timing or the consideration of CGM use. B If deterioration of medical status is associated with significant weight gain or loss, inpatient evaluation should be considered, specifically focused on the association between medication use, food intake, and glycemic status. A, 6.16 Ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia by the clinician, patient, and caregivers if low cognition or declining cognition is found. A concern that statins or other lipid-lowering agents might cause cognitive dysfunction or dementia is not currently supported by evidence and should not deter their use in individuals with diabetes at high risk for ASCVD. C, 10.17 In adults not taking statins or other lipid-lowering therapy, it is reasonable to obtain a lipid profile at the time of diabetes diagnosis, at an initial medical evaluation, and every 5 years thereafter if under the age of 40 years, or more frequently if indicated. The recommendations, tables, and figures included here retain the same numbering used in the complete 2020 Standards and so are not numbered sequentially in this abridged version. A, 1.6 Refer patients to local community resources when available. E, 12.16 Patients with diabetes residing in long-term care facilities need careful assessment to establish individualized glycemic goals and to make appropriate choices of glucose-lowering agents based on their clinical and functional status. With annual updates since 1989, the American Diabetes Association (ADA) has long been a leader in producing guidelines … E, 13.60 Less-stringent A1C goals (such as 7.5% [58 mmol/mol]) may be appropriate if there is increased risk of hypoglycemia. The following best-practice guidelines for the prevention, diagnosis and management of diabetes that have been developed for health professionals by medical experts and researchers. Diabetes Care in the Hospital” in the complete 2020 Standards of Care for a comprehensive review of the inpatient use of these medications. 6.6 An A1C goal for many nonpregnant adults of <7% (53 mmol/mol) is appropriate. Since then more information relevant to the diagnosis of diabetes has become available. E, 6.4 Standardized, single-page glucose reports with visual cues such as the Ambulatory Glucose Profile (AGP) should be considered as a standard printout for all CGM devices. Therefore, macronutrient distribution should be based on an individualized assessment of current eating patterns, preferences, and metabolic goals. B, 11.27 Symptoms and signs of autonomic neuropathy should be assessed in patients with microvascular complications. E. Depicted are patient and disease factors used to determine optimal A1C targets. B, 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. The patient’s medications must be cross-checked to ensure that no chronic medications were stopped and to ensure the safety of new prescriptions. The American College of Cardiology’s designated representatives (for Section 10) were Sandeep Das, MD, MPH, FACC, and Mikhail Kosiborod, MD, FACC. ADA and EASD Consensus Report (2020) Diabetes digital app technology: benefits, challenges, and recommendations. Children and Adolescents,” and “14. “14. B, 10.36 Dual antiplatelet therapy (with low-dose aspirin and a P2Y12 inhibitor) is reasonable for a year after an acute coronary syndrome A and may have benefits beyond this period.