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| 3. Changes in ADA standards of Diabetes Care 2009 |
Every year at the beginning, the American Diabetes Association (ADA) publishes their thoroughly reviewed and revised Standards of Medical Care in Diabetes, which cover a wide area from prevention and diagnosis to management of diabetes and related disorders and complications. |
| Bariatric surgery section has been added: People with BMI > 35 and difficult to control with lifestyle and pharmacologic therapy are suggested for Bariatric surgery. Surgery shouldn’t be recommended due to lack of evidence for people with BMI with 30 – 35. The standards also suggest that people who have bariatric surgery need life-long lifestyle support and medical monitoring. |
| Dyslipidemia and coronary heart disease treatment changes: If a person who is treated with maximal tolerated statin therapy doesn’t reach suggested ADA targets (without overt Cardio Vascular Disease < 100 mg/dl, with overt Cardio Vascular Disease < 70 mg/dl), a reduction in LDL cholesterol of 30-40% from baseline is an alternative goal. |
| Blood pressure treatment: For children having consistently high blood pressure (between the 90-95th percentile for age, sex, and height) dietary intervention and exercise aimed at weight control and physical activity, are suggested if appropriate. The treatment goal is consistent BP below 130/80 or 90th percentile (whichever is lower). |
| Diabetes care in the hospital: Critically ill surgical patients’ BG should be kept as close to 110 mg/dl as possible and generally <140 mg/dl. |
| Prevention/delay of type 2 diabetes: Repeated counselling to make lifestyle changes is recommended. The life style changes should aim for weight loss of 5-10% of body weight and for increasing physical activity to at least 150 min per week of moderate activity such as walking. |
| A1C and eAG (estimated average glucose): A “less stringent” A1c may be appropriate for people with a history of severe hypoglycemia, limited life expectancy, advanced micro- or macro vascular disease, and extensive co morbid conditions and those with longstanding diabetes in whom < 7% A1c is difficult to attain. |
| An A1c “closer to normal” may offer some people an incremental decrease in micro vascular disease as long as there is no significant hypoglycemia or other adverse effects of treatment. This subgroup may include people with short duration of diabetes, long life expectancy and no significant CVD. |
| The medical practitioners reading this newsletter are encouraged to read the complete 2009 Standards of Care, the Executive Summary or simply the summary of changes in Diabetes Care or at www.diabetes.org. |
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This newsletter is published for free distribution through the Internet for doctors, patients and public for promoting healthy lifestyles. For enquiries, please contact Sunitha Jothydev, CAO, Jothydev’s Diabetes Centre, Trivandrum. Please visit: http://www.jothydev.net |