Download Strategies for improving Care

Diabetes Journal Club
Carina Signori
Endocrinology Fellow

ADA Standards of Medical Care 2012
◦ Revisions
 Changes related to new evidence or to clarify
recommendations from 2011.
 Recommendations for transition from pediatric to
adult care.
 Section on cystic fibrosis related diabetes.
 Strategies for improving diabetes care was revised to
reflect evidence for the effectiveness of restructuring
systems of chronic care delivery.
Diagnosis of Diabetes
Mellitus
Diagnosis of Gestational
Diabetes
Prevention of type 2 DM
Glycemic goals
2011
guidelines
give A1C
≥6%
Primary Prevention of DM

Based on a meta-analysis
of 8 prospectve cohort
studies (N=310,819)
◦ High consumption of
sugar-sweetened
beverages was associated
with the development of
type 2 diabetes (n=15043).
◦ Individuals in the highest
vs lowest quantile of
sugar-sweetened beverage
intake had 26% greater risk
of developing diabetes.
Recommendations for
management of DM
Physical Activity
New
Addition
Management of HTN
Evidence for 2012
Revisions


The ADVANCE trial
◦ showed that combination ACEI
(perindopril) plus diuretic
(indapamide) reduced micro
and macrovascular
complications and CVD total
and total mortality.
ACCOMPLISH trial showed a
decrease in morbidity and
mortality in those receiving
ACEI (benazepril) and
amlodipine vs benazepril
and HCTZ.
2011 guidelines specifically recommend HCTZ if GFR >30 or
loop diuretic if GFR <30 if BP is still not controlled with
ACEI/ARB.

New section
◦ As teens transition into adulthood, health care
providers and families must:
 Recognize their vulnerabilities. (B)
 Prepare the developing teen, beginning in early to
mid-adolescence and at least 1 year prior to the
transition. (E)
◦ Both pediatricians and adult health care providers
should assist in providing support and links to
resources for the teen and emerging adult .(B)

Annual screening for CFRD with OGTT should
begin by age 10 years in all patients with CF who
do not have CFRD (B).
◦ Use of A1C as a screening test is not recommended.



During a period of stable health the diagnosis of
CFRD can be made in CF patients according to
usual diagnostic criteria. (E)
Patients with CFRD should be treated with insulin
to attain individualized glycemic goals. (A)
Annual monitoring for complications of diabetes
is recommended, beginning 5 years after the
diagnosis of CFRD. (E)

Care should be aligned with
components of the Chronic
Care Model to ensure
productive interactions
between a prepared proactive
practice team and an
informed activated patient.
(A)



When feasible, care systems
should support team-based
care, community
involvement, patient
registries, and embedded
decision support tools to
meet patient needs. (B)
Treatment decisions should
be timely and based on
evidence-based guidelines
that are tailored to individual
patient preferences,
prognoses, and
comorbidities. (B)
A patient centered
communication style should
be employed that
incorporates patient
preferences, assesses literacy
and numeracy, and addresses
cultural barriers to care. (B)