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Abridged Diabetes Guidelines for Primary Care: 6 Noteworthy Changes

Abridged Diabetes Guidelines for Primary Care: 6 Noteworthy Changes

  • American Diabetes Association. Standards of Medical Care in Diabetes—2015. Abridged for Primary Care Providers. Clin Diabetes. 2015;33:97-111. More information, here.
  • Contain evidence-based recommendations relevant to PCPs who care for patients with T2DM. The focus is on patient-centered communication that incorporates patient preferences, assesses literacy, numeracy, addresses cultural barriers to care. The guidelines also include updates, 6 of which are particularly important for primary care providers.
  • Consider testing for diabetes and prediabetes in Asian Americans with a body mass index (BMI) of 23 kg/m2 or higher. This is a decrease from last year's recommendation of testing of individuals with a BMI of 25 kg/m2 or higher.
  • Glycemic targets are now 80 to 130 mg/dL, which is higher than the target of 70 to 130 mg/dL that was recommended last year.
  • An updated diabetes type 2 treatment algorithm includes newer therapies such as the DPP-4 inhibitors, GLP-1 receptor agonists, and the SGLT2 inhibitors.
  • The initiation and intensification of statin therapy is now based on age and risk factors. This reflects a change from recommending treatment on the basis of cholesterol measurements to determining treatment based on risk stratification.
  • Perform a foot exam on patients with diabetes at every visit, and not just annually, as was recommended last year (2014).
  • The new A1C goal for children and adolescents is lower than 7.5%, regardless of age. This represents a lowering of the goal for children younger than 12 years.
  • When a patient is not readily meeting treatment goals, reassessment is essential and may require close evaluation of patient-specific barriers, including: cultural issues, income, health literacy, diabetes-related distress, depression, poverty, competing demands (eg, those related to family responsibilities/dynamics).
  • In a March issue of the Annals of Internal Medicine, Drs Giulio Romeo and Martin J Abrahamson, from the Joslin Diabetes Center in Boston, highlighted what they found to be the most important updates to the 2015 ADA Standards of Medical Care. The article concludes with the quote above that reinforces the importance of evaluating and treating each patient with diabetes based on the specifics of his/her life and health. Romeo GR, Abrahamson MJ. The 2015 Standards for Diabetes Care: Maintaining a Patient-Centered Approach. Ann Intern Med. Published online 24 March 2015 doi: 10.7326/M15-0385. More information, here.

An abridged version of the 2015 Standards of Medical Care in Diabetes was just released by the ADA and the ADA Primary Care Advisory Group and is available in the most recent issue of Clinical Diabetes. An effort was made to include recommendations most relevant to the primary care clinicians in the United States who provide the majority of care for patients with diabetes. The abridged version reiterates the core principle of the original 2015 guidelines—the patient and his/her needs and preferences must guide all decisions about diabetes management.

2015 changes of note included in the abridged guideline include:

♦ Diabetes testing in Asian Americans

♦ Change in glycemic targets

♦ Updates to the T2DM treatment algorithm

♦ Use of statin therapy in T2DM

♦ The importance of regular foot examinations

♦ A1c goal in children

The full 2015 Standards of Care document is available on the ADA website.

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