ManagementofType2DiabetesMellitus.pdf

Guidelines for Clinical Care Ambulatory Diabetes Mellitus Guideline Team Management of Type 2 Diabetes Mellitus Team Leaders Connie J Standiford, MD General Internal Medicine Sandeep Vijan, MD General Internal Medicine Team Members Patient population. Adults Objectives. To reduce morbidity and mortality by improving adherence to important recommendations for preventing, detecting, and managing diabetic complications. Key points Hae Mi Choe, PharmD College of Pharmacy R Van Harrison, PhD Medical Education Caroline R Richardson, MD Family Medicine Prevention. In individuals at risk for type 2 diabetes (see Table 1), type 2 diabetes can be delayed or prevented through diet, exercise, and pharmacologic interventions [IA]. Screening. Although little evidence is available on screening for diabetes, screening should be considered every 3 years beginning at age 45 or annually at any age if BMI ≥ 25 kg/m2 [evidence: IID], history of hypertension [IIB], gestational diabetes [IC], or other risk factors. Jennifer A Wyckoff, MD Diagnosis. An A1c of 6.5% or greater, confirmed by second test, is diagnostic of diabetes. Alternatively, Metabolism, Endocrinology Diabetes diabetes can be diagnosed by two separate fasting glucoses ≥ 126 mg/dL; with symptoms, a glucose ≥ 200 mg/dL confirmed on a separate day by a fasting glucose ≥ 126 mg/dL; or 2-hour postload glucose ≥ Consultants 200 mg/dl during an oral glucose tolerance test [B]. (See Table 1. See Table 2 for differential diagnosis.) Martha M Funnell, MS, RN, CDE Treatment. Essential components of the treatment for diabetes include diabetes self-management education Diabetes Research and Training Center William H Herman, MD Metabolism, Endocrine and support, lifestyle interventions, and goal setting (see Table 3); glycemic management (see Tables 410); and pharmacologic management of hypertension (see Table 11) and hyperlipidemia. Screening for comorbidities and complications. Routine screening and prompt treatment for Diabetes car