C, Treatment of hypertension to individualized target levels is indicated in most older adults. DSMES has been shown to reduce DD. Treatment goals and plans for meeting them should be created collaboratively with patients (Figure 1). Although it is well recognized that the frequency of a first ASCVD event in adults with diabetes mellitus is significantly increased compared with those without diabetes mellitus, there is a wide spectrum of risk among individuals with diabetes mellitus S4.3-5,S4.3-6,S4.3-8,S4.3-9 that varies with age, duration of diabetes mellitus, … C, Provide general preventive foot self-care education to all patients with diabetes. Potential benefits must be weighed against the potential risks of the medications. OBESITY MANAGEMENT FOR THE TREATMENT OF TYPE 2 DIABETES, 9. E. Due to the continuous change in insulin requirements during pregnancy, regular monitoring of blood glucose and insulin adjustments are necessary. However, in the absence of other symptoms (e.g., weight loss, abdominal pain), routine screening of all such patients is not currently recommended. C, 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. Glycemic Targets” in the complete 2019 Standards of Care for the justification for current glycemic control recommendations. B, Overtreatment of diabetes is common in older adults and should be avoided. If retinopathy is progressing or sight-threatening, then examinations will be required more frequently. We do not capture any email address. B, The use of specialized therapeutic footwear is recommended for high-risk patients with diabetes including those with severe neuropathy, foot deformities, or history of amputation. This is an abridged version of the 2019 Standards containing the evidence-based recommendations most pertinent to primary care. Institutional Subscriptions and Site Licenses, Special Podcast Series: Therapeutic Inertia, Special Podcast Series: Influenza Podcasts, Standards of Medical Care in Diabetes—2019 Abridged for Primary Care Providers, 1. More information is available at http://www.diabetesjournals.org/content/license. B, All hypertensive patients with diabetes should monitor their blood pressure at home. Therapeutic strategies (pharmacologic and nonpharmacologic) for the relief of painful DPN and symptoms of autonomic neuropathy can potentially reduce pain and improve quality of life. Lipid-lowering therapy and aspirin therapy may benefit those with life expectancies at least equal to the time frame of primary prevention or secondary intervention trials. B, Assessment for distal symmetric polyneuropathy should include a careful history and assessment of either temperature or pinprick sensation (small-fiber function) and vibration sensation using a 128-Hz tuning fork (for large-fiber function). For best practice, hospitals should establish protocols for structured patient care and structured order sets, which include computerized physician order entry. The early recognition and appropriate management of neuropathy in the patient with diabetes is important. Appropriate patients might include those with short duration of diabetes, type 2 diabetes treated with lifestyle or metformin only, long life expectancy, or no significant cardiovascular disease. After adjusting for inflation, economic costs of diabetes increased by 26% from 2012 to 2017. Patrick T. O’Gara, MD, MACC, FAHA. Table 5 highlights considerations for a patient-centered approach to choosing appropriate pharmacologic treatment of blood glucose. Diabetes Care 2018;41:2669–2701. Diabetes and prediabetes may be screened based on plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h plasma glucose (2-h PG) value during a 75-g oral glucose tolerance test (OGTT), or A1C criteria (Table 3). FRC, fixed-ratio combination; GLP-1 RA, GLP-1 receptor agonist; Hba1c, glycated hemoglobin; iDegLira, insulin degludec/liraglutide; iGlarLixi; insulin glargine/lixsenatide; max, maximum; PPG, postprandial glucose. Providers should assess social context, including potential food insecurity, housing stability, and financial barriers, and apply that information to treatment decisions. Whereas overall healthy low-calorie eating patterns should be encouraged, there is also some evidence that particular dietary components impact diabetes risk in observational studies. B, Deintensification (or simplification) of complex regimens is recommended to reduce the risk of hypoglycemia, if it can be achieved within the individualized A1C target. A, An A1C target of <7.5% (58 mmol/mol) should be considered in children and adolescents with type 1 diabetes but should be individualized based on the needs and situation of the patient and family. The goals of treatment for diabetes are to prevent or delay complications and maintain quality of life. A. A, Consider educating individuals with type 1 diabetes on matching prandial insulin doses to carbohydrate intake, premeal blood glucose levels, and anticipated physical activity. Patient interest will certainly be a driver for more widespread use of diabetes technology, and this may include primary care practices caring for those with diabetes. E, A patient-centered approach should be used to guide the choice of pharmacologic agents. Women with type 1 or type 2 diabetes should be prescribed low-dose aspirin 60–150 mg/day (usual dose 81 mg/day) from the end of the first trimester until the baby is born in order to lower the risk of preeclampsia. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 2018;42(Suppl. Individualization of health care is important for all patients. There is strong and consistent evidence that obesity management is beneficial in the treatment of type 2 diabetes. B If one class is not tolerated, the other should be substituted. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Patients with diabetes should be encouraged to undergo recommended age- and sex-appropriate cancer screenings and to reduce their modifiable cancer risk factors (obesity, physical inactivity, and smoking). Decision cycle for patient-centered glycemic management in type 2 diabetes. For patients with fasting triglyceride levels ≥500 mg/dL (5.7 mmol/L), evaluate for secondary causes of hypertriglyceridemia and consider medical therapy to reduce the risk of pancreatitis.
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