The new American Diabetes Association
2016 guidelines are now posted and the ADA is apparently attempting
to be politically correct. The word diabetic will no longer be used
to describe patients, but will only be used as an adjective when
describing something like diabetic neuropathy. OH -WOW! And, there
are more examples of political correctness through out the
guidelines.
Strategies for improving care has been
revised – including recommendations on tailoring treatment to
vulnerable populations with diabetes, including recommendations for
those with food insecurity, cognitive dysfunction and/or mental
illness, and HIV, and a discussion on disparities related to
ethnicity, culture, sex, socioeconomic differences, and disparities.
The support for only diagnosing based
on HbA1c has been diminished and includes fasting plasma glucose,
75-gram oral glucose tolerance test, and the A1c test, with no
preference to one test. The screening recommendations have now been
revised to test all adults beginning at age 45 years, regardless of
weight.
Two sections were combined – Initial
Evaluation and Diabetes Management Planning and Foundations of Care:
Education, Nutrition, Physical Activity, Smoking Cessation,
Psychosocial Care, and Immunization from the 2015 Standards were
combined into one section for 2016 to reflect the importance of
integrating medical evaluation, patient engagement, and ongoing care
that highlight the importance of lifestyle and behavioral
modification. The nutrition and vaccination recommendations were
streamlined to focus on those aspects of care most important and most
relevant to people with diabetes.
Many people will be happy to see this -
Because of the growing number of older adults with insulin-dependent
diabetes, the ADA added the recommendation that people who use
continuous glucose monitoring and insulin pumps should have continued
access after they turn 65 years of age. Now we will need to push out
congressional representatives to pass a bill to force Medicare to do
this.
“Atherosclerotic cardiovascular
disease” (ASCVD) has replaced the former term “cardiovascular
disease” (CVD), as ASCVD is a more specific term.
A new recommendation for pharmacological treatment of older adults
was added. To reflect new evidence on ASCVD risk among women, the
recommendation to consider aspirin therapy in women aged greater than
60 years has been changed to include women aged 50 years and greater.
A recommendation was also added to address antiplatelet use in
patients aged less than 50 years with multiple risk factors.
A recommendation was made to reflect new evidence that adding
ezetimibe to moderate-intensity statin provides additional
cardiovascular benefits for select individuals with diabetes and
should be considered. A new table provides efficacy and dose details
on high- and moderate-intensity statin therapy.
“Nephropathy” was changed to
“diabetic kidney disease” to emphasize that, while nephropathy
may stem from a variety of causes, attention is placed on kidney
disease that is directly related to diabetes. There are several minor
edits to this section. The significant ones, based on new evidence,
are as follows:
Diabetic kidney
disease: guidance was added on when to refer for renal replacement
treatment and when to refer to physicians experienced in the care of
diabetic kidney disease.
Diabetic
retinopathy: guidance was added on the use of intravitreal anti-VEGF
agents for the treatment of center-involved diabetic macular edema,
as they were more effective than monotherapy or combination therapy
with laser.
The scope of youth section is more
comprehensive, capturing the nuances of diabetes care in the
pediatric population. This includes new recommendations addressing
diabetes self-management education and support, psychosocial issues,
and treatment guidelines for type 2 diabetes in youth.
The recommendation
to obtain a fasting lipid profile in children starting at age 2 years
has been changed to age 10 years, based on a scientific statement on
type 1 diabetes and cardiovascular disease from the American Heart
Association and the ADA.
There is more and I may cover some of
this separately at a later date. Find the Table of Contents here.
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