E, 10.40 In patients with known ASCVD, consider ACE inhibitor or ARB therapy to reduce the risk of CV events. Screening for diabetes complications in older adults should be individualized and periodically revisited, as the results of screening tests may impact targets and therapeutic approaches. Diabetes Advocacy” in the complete 2020 Standards of Care. B, 6.9 Reassess glycemic targets over time based on the criteria in Figure 6.2. B. Diabetes is an important health condition for the aging population. The diet should not be high in saturated fat. Table 8.2 in the complete 2020 Standards of Care provides a list of FDA-approved medications for the treatment of obesity, along with their advantages and disadvantages. B, 10.22 In adults with diabetes and 10-year ASCVD risk of 20% or higher, it may be reasonable to add ezetimibe to maximally tolerated statin therapy to reduce LDL cholesterol levels by 50% or more. Those who are determined to be at high risk for type 2 diabetes, including people with an A1C of 5.7–6.4% (39–47 mmol/mol), impaired glucose tolerance, or impaired fasting glucose, are ideal candidates for diabetes prevention efforts. B. B. Although no drugs have been approved by the U.S. Food and Drug Administration (FDA) for diabetes prevention, several have shown promise in research studies.
Type 1 diabetes is the most common form of diabetes in youth.
B, 11.7 In nonpregnant patients with diabetes and hypertension, either an ACE inhibitor or an ARB is recommended for those with modestly elevated UACR (30–299 mg/g Cr) B and is strongly recommended for those with UACR ≥300 mg/g Cr and/or eGFR <60 mL/min/1.73 m2. B, 12.12 Overtreatment of diabetes is common in older adults and should be avoided. Validated tools are available to measure the level of distress and identify issues that care team members may address. B, 4.4 A follow-up visit should include most components of the initial comprehensive medical evaluation, including interval medical history, assessment of medication-taking behavior and intolerance/side effects, physical examination, laboratory evaluation as appropriate to assess attainment of A1C and metabolic targets, and assessment of risk for complications, diabetes self-management behaviors, nutrition, psychosocial health, and the need for referrals, immunizations, or other routine health maintenance screening. B. Potential benefits must be weighed against potential risks of medications. The American Diabetes Association’s (ADA’s) Standards of Medical Care in Diabetes is updated and published annually in a supplement to the January issue of Diabetes Care. Once SMBG returns to normal, the individual should consume a meal or snack to prevent recurrence of hypoglycemia. Use of custom therapeutic footwear can help reduce the risk of future foot ulcers in high-risk patients. This is an abridged version of the American Diabetes Association’s Standards of Medical Care in Diabetes—2020. B, 11.6 For people with nondialysis-dependent CKD, dietary protein intake should be approximately 0.8 g/kg body weight per day (the recommended daily allowance). The Standards of Medical Care in Diabetes is updated annually, or more frequently online if new evidence or regulatory changes merit immediate incorporation, and is published in Diabetes Care. B, 5.44 Annually screen people who are prescribed atypical antipsychotic medications for prediabetes or diabetes.
Decision cycle for patient-centered glycemic management in type 2 diabetes. BP, blood pressure. 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. Community resources and policies (identifying or developing resources to support healthy lifestyles), 6. B, 3.9 Diabetes self-management education and support (DSMES) programs may be appropriate venues for people with prediabetes to receive education and support to develop and maintain behaviors that can prevent or delay the development of type 2 diabetes.
1):S1–S212. 12.3 Screening for early detection of mild cognitive impairment or dementia should be performed for adults 65 years of age or older at the initial visit and annually as appropriate. 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).
Microvascular Complications and Foot Care” in the complete 2020 Standards of Care provides further details on appropriate screening. C, 8.7 As all energy-deficit food intake will result in weight loss, eating plans should be individualized to meet the patient’s protein, fat, and carbohydrate needs while still promoting weight loss. Special care is required in prescribing and monitoring pharmacologic therapies in older adults. The same study suggested that health care utilization was lower in the CCM group, resulting in health care savings of $7,294 per individual over the study period. However, there are insufficient data on clinical outcomes, safety, and cost-effectiveness to recommend using CGM in hospitalized patients. “11. B, 10.27 In adults with diabetes aged >75 years, it may be reasonable to initiate statin therapy after discussion of potential benefits and risks. The complete 2020 Standards of Care, including all supporting references, is available at professional.diabetes.org/standards. E, 8.4 Diet, physical activity, and behavioral therapy designed to achieve and maintain ≥5% weight loss is recommended for patients with type 2 diabetes who have overweight or obesity and are ready to achieve weight loss. A, 14.3 Preconception counseling should address the importance of achieving glucose levels as close to normal as is safely possible, ideally A1C <6.5% (48 mmol/mol), to reduce the risk of congenital anomalies, preeclampsia, macrosomia, and other complications. (See “6. An individualized eating pattern considers the individual’s health status, skills, resources, food preferences, and health goals. Type 2 diabetes (due to a progressive loss of β-cell insulin secretion frequently on the background of insulin resistance), 3. 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. 10.34 Use aspirin therapy (75–162 mg/day) as a secondary prevention strategy in those with diabetes and a history of ASCVD. Diabetes Care 2018;41:2669–2701. Provide a password for the new account in both fields. B, 1.7 Provide patients with self-management support from lay health coaches, navigators, or community health workers when available. It also has been shown to be beneficial in the treatment of type 2 diabetes. E, 10.19 For patients with diabetes aged 40–75 years without ASCVD, use moderate-intensity statin therapy in addition to lifestyle therapy.
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