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Heart failure is another major cause of morbidity and mortality from CVD.For prevention and management of both ASCVD and heart failure, cardiovascular risk factors should be systematically assessed at least annually in all patients with diabetes. Point-of-care testing for A1C provides the opportunity for more timely treatment changes. Metformin has the strongest evidence base and demonstrated long-term safety as pharmacologic therapy for diabetes prevention. Evidence is strong for treatment of hypertension. The meeting was attended by over 15,000 professional attendees from 115 countries, … Similar to the targets recommended by the American College of Obstetricians and Gynecologists (the same as for GDM; described below), the ADA recommended targets for women with type 1 or type 2 diabetes are as follows:Lifestyle change is an essential component of management of GDM and may suffice for the treatment of many women. Children and adolescents with overweight/obesity in whom the diagnosis of type 2 diabetes is being considered should have a panel of pancreatic autoantibodies tested to exclude the possibility of autoimmune type 1 diabetes. For patients with diabetes and ASCVD, if LDL cholesterol is ≥70 mg/dL on maximally tolerated statin dose, consider adding additional LDL-lowering therapy (such as ezetimibe or PCSK9 inhibitor). For patients on dialysis, higher levels of dietary protein intake should be considered. More recently, diabetes technology has expanded to include hybrid devices that both monitor glucose and deliver insulin, some automatically, as well as software that serves as a medical device, providing diabetes self-management support. CKD Stages and Corresponding Focus of Kidney-Related CareThe FDA revised its guidance for the use of metformin in CKD in 2016, stating that metformin is contraindicated in patients with an eGFR <30 mL/min/1.73 mSee Sec. Glucagon should be prescribed for all individuals at increased risk of level 2 hypoglycemia, defined as blood glucose <54 mg/dL (3.0 mmol/L), so it is available should it be needed. Patients with confirmed office-based blood pressure ≥140/90 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of pharmacologic therapy to achieve blood pressure goals. Insulin is the preferred medication for treating hyperglycemia in GDM as it does not cross the placenta to a measurable extent. 0000003253 00000 n The tables and figures have been renum- bered from the original document to match this version. For best practice, hospitals should establish protocols for structured patient care and structured order sets, which include computerized physician order entry.Insulin should be administered using validated written or computerized protocols that allow for predefined adjustments in the insulin dosage based on glycemic fluctuations. Use of custom therapeutic footwear can help reduce the risk of future foot ulcers in high-risk patients.Diabetes is an important health condition for the aging population, as approximately one-quarter of people over the age of 65 years have diabetes and one-half of older adults have prediabetes. The recommendations are based on an extensive review of the clinical diabetes … Long-term use of metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy. For individuals with diabetes and hypertension at lower risk for cardiovascular disease (10-year ASCVD risk <15%), treat to a blood pressure target of <140/90 mmHg. In addition, research indicates that low-carbohydrate eating plans may result in improved glycemia and have the potential to reduce antihyperglycemic medications for individuals with type 2 diabetes. A plan for preventing and treating hypoglycemia should be established for each patient. All oral agents lack long-term safety data. It is difficult to assess each component of such a complex intervention.“Standards of Medical Care in Diabetes” was originally approved in 1988. Each person with diabetes should be actively engaged in developing an individualized eating plan. %PDF-1.5 %���� An insulin regimen with basal, prandial, and correction components is the preferred treatment for noncritically ill hospitalized patients with good nutritional intake. �_�2��ټH�ү�z��w.��. 2. Considerations include comorbidities (ASCVD, heart failure, CKD), hypoglycemia risk, impact on weight, cost, risk for side effects, and patient preferences.

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