Standards of Medical Care in Diabetes 2017

Standards of Medical Care in Diabetes—2017

Evidence Table

Recommendation / Reason for Change / 2016 references that support recommendation (list citation #) / New Evidence for 2017 (hyperlinked reference title/s)
Strategies for improving Care
A patient-centered communication style usingthat active listening to elicit incorporates patient preferences and, assesses literacy, and numeracy, and addresses cultural barriers to care should be usedshould be incorporated into treatment strategies to optimize health outcomes and health-related quality of life. B / Now provides recommendation on a skill that can help providers get the information from patients that they need to inform treatment.
Do we want to say anything about goal setting here? (reference 10) and also could just say overcoming barriers (since literacy/numeracy covered later) / 13, 14-17, 55 / http://www.ncbi.nlm.nih.gov/pubmed/26699083
Treatment decisions should be timely, and based on evidence-based guidelines, and made in collaboration with patients based on that are tailored to individual patient preferences, prognoses, and comorbidities. B / Should include mention of collaboration/shared decision making / 6, 10, 12 (timely),
18-20, 34 / http://www.ncbi.nlm.nih.gov/pubmed/26458383
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 / 7,8 (CCM)
29, 30 (activated patients) / New review article (2015) in Journal of Evaluation in Clinical Practice (IF 1.05), but current references are in higher tier journal and conclusions are similar
7- Preventing Chronic Disease (IF 2.17)
8- Health Affairs (IF 5.23)
Providers should consider the burden of treatment and patient levels of confidence/self-efficacy for management behaviors as treatment recommendations are made. E
When feasible, care systems should support team-based care, community involvement, patient registries, and decision support tools to meet patient needs. B / Community involvement language could stay here or move to new section / 6,7, 9-11, 21, 22
Providers should assess social context, including potential food insecurity, housing stability, and financial barriers (to treatment adherence?) and apply to treatment decisions.A / Proposed heading: Social Determinants of Health
This broadens the recommendation to incorporate other important aspects of SDH but still names food insecurity/homelessness
Add information to text about what “appropriate resources” means / 6, 14-17, 59 / http://content.healthaffairs.org/content/34/11/1956
Providers should evaluate hyperglycemia and hypoglycemia in the context of food insecurity and propose solutions accordingly. A / 59
Providers should recognize that homelessness, poor literacy, and poor numeracy often occur with food insecurity, and appropriate resources should be made available for patients with diabetes. A
Referral to existing local community resources should be made when available B / Proposed heading: Community support
Increasing evidence that integration of care management efforts that extend to the community warrants inclusion of support and community as a distinct bullet / 6, 7, 31 / Have ordered an article- need to review in its entirety
Provision of support for self-management from lay health coaches, navigators, or community health workers should be made available when feasible A / See above / 49, 50, 51, 52, 54
Intensive glucose control is not advised for the improvement of poor cognitive function in hyperglycemic individuals with type 2 diabetes. Treatment should be tailored to avoid significant hypoglycemia B / 63
In individuals with poor cognitive function or severe hypoglycemia, glycemic therapy should be tailored to avoid significant hypoglycemia. C / This bullet seems a bit redundanthypoglycemia language / 63
In individuals with diabetes at high cardiovascular risk, the cardiovascular benefits of statin therapy outweigh the risk of cognitive dysfunction. A / Discuss how statins don’t affect cognitive function negatively in text / 68
If a second-generation antipsychotic medication is prescribed for adolescents or adults, with or without diabetes, changes in weight, blood glucose levelsglycemic control, and cholesterol levels should be carefully monitored and the treatment regimen should be reassessed. C / New data regarding elevated risk for adolescents / 73 / http://www.ncbi.nlm.nih.gov/pubmed/26792761
All pPatients with HIV should be testedscreened for diabetes and prediabetes with a fasting glucose level every 6-12 months as well as before starting antiretroviral therapy and 3 months after starting or changing it. If initial screening results are normal, checking fasting glucose each year is advised. If prediabetes is detected, continue to measure levels every 3–6 months to monitor for progression to diabetes. E / Changed to be more consistent with stated guidelines
Is this supposed to be a fasting glucose level specifically, and not any other glucose measure?
Screening versus testing / 75 (2002)
76 (2006 / Clinical Infectious Disease (2015)
http://www.ncbi.nlm.nih.gov/pubmed/25313249
Classification and Diagnosis of Diabetes
Testing Screening to assess risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and in all adults. Testing is suggested in those who have one one or more additional risk factors for diabetes. B / Dr. Herman would like to lead a discussion among the PPC about possible revision.
Table 2.2 edit
Describe process in text, differentiation between screening for risk factors and testing for diabetes
Except for GDM—create separate bullet point for follow-up with GDM
Refer to ADA risk text?
Add commentary in text regarding ethnicity—ie lean, * in table, African americans. Add data, reference about how it’s mostly family history. / 10,11 / For Discussion:
Wang B, Zhuang R, Luo X, et al. Prevalence of metabolically healthy obese and metabolically obese but normal weight in adults worldwide: A meta-analysis. Horm Metab Res 2015;47:839-845
Lotta LA, Abbasi A, Sharp SJ, et al. Definitions of metabolic health and risk of future type 2 diabetes in body mass index categories: a systematic review and network meta-analysis. Diabetes Care 2015;38(11):2177-2187
Lee SH, Yang HK, Ha HS, et al. Changes in metabolic health status over time and risk of developing type 2 diabetes: A prospective cohort study. Medicine (Baltimore) 2015;94(40):e1705.
For all patients, testing should begin at age 45 years. B / No Change Recommended / 10,11,24
If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable. C / No Change Recommended / 10,11,32
To test for prediabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate. B / No Change Recommended
Make change to recommendation and narrative in response to recent FDA advisory panel meeting on POC A1C testing? / 10-15 / For Discussion (Dr. Ratner):
MedPage Today Story
In patients with prediabetes, identify and, if appropriate, treat other cardiovascular disease risk factors. B / No Change Recommended / 10,11
Testing to detect prediabetes should be considered in children and adolescents who are overweight or obese and who have two or more additional risk factors for diabetes. E / No Change Recommended / 16,33-36 / Possible addition?
Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care 2000;23(3):381-389
Blood glucose rather than A1C should be used to diagnose acute onset of type 1 diabetes in individuals with symptoms of hyperglycemia. E / No Change Recommended / 2
Inform the relatives of patients with type 1 diabetes of the opportunity to be tested for type 1 diabetes risk, but only in the setting of a clinical research study. E / No Change Recommended / No references currently cited in 2016 standards (supported by narrative and reference to clinicaltrials.gov)
Add GAD or antibody panel recommendation to catch adult-onset type 1 diabetes / Add short paragraph in type 2 diabetes section, describing LADA without saying LADA
Testing to detect type 2 diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes. B / Dr. Herman would like to lead a discussion among the PPC about possible revision.
Added a subsection on “Screening in Dental Clinics” for consideration / 21,25-27 / For Discussion:
Wang B, Zhuang R, Luo X, et al. Prevalence of metabolically healthy obese and metabolically obese but normal weight in adults worldwide: A meta-analysis. Horm Metab Res 2015;47:839-845
Lotta LA, Abbasi A, Sharp SJ, et al. Definitions of metabolic health and risk of future type 2 diabetes in body mass index categories: a systematic review and network meta-analysis. Diabetes Care 2015;38(11):2177-2187
Lee SH, Yang HK, Ha HS, et al. Changes in metabolic health status over time and risk of developing type 2 diabetes: A prospective cohort study. Medicine (Baltimore) 2015;94(40):e1705.
Dental Clinic Screening References:
Lalla E, Kunzel C, Burkett S, et al. Identification of unrecognized diabetes and pre-diabetes in a dental setting. J Dent Res 2011;90(7):855-860
Lalla E, Cheng B, Kunzel C, et al. Dental findings and identification of undiagnosed hyperglycemia. J Dent Res 2013;92(10):888-892
Herman WH, Taylor GW, Jacobson JJ, et al. Screening for prediabetes and type 2 diabetes in dental offices. J Public Health Dent 2015;75(3):175-182
For all patientspeople, testing should begin at age 45 years. B / No Change Recommended / 10,11,24
If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable. C / No Change Recommended / 10,11,32
To test for type 2 diabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate. B / No Change Recommended / 10-15
In patients with diabetes, identify and, if appropriate, treat other cardiovascular disease risk factors. B / No Change Recommended / 22,23
Testing to detect type 2 diabetes should be considered in children and adolescents who are overweight or obese and who have two or more additional risk factors for diabetes. E / No Change Recommended / 16,33-36 / Possible addition?
Type 2 diabetes in children and adolescents. American Diabetes Association. Diabetes Care 2000;23(3):381-389
Test for undiagnosed type 2 diabetes at the first prenatal visit in those with risk factors, using standard diagnostic criteria. B / No Change Recommended / 37,38,
Test for gestational diabetes mellitus at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. A / Question for Discussion:
Maintain current recommendations per Table 2.5, or should this be changed to recommend one-step strategy only? If the two-step strategy stays in the table, should it be simplified to include either reference 55 or 56 only (for simplification)? / 39,40-47 / Donovan L, Hartling L, Muise M, Guthrie A, Vandermeer B, Dryden DM. Screening tests for gestational diabetes: a systematic review for the U.S. Preventive Services Task Force. Annals of Internal medicine 2013: 159: 1-8.
Khalafallah A, Phuah E, Al-Barazan AM, Nikakis I, Radford A, Clarkson W, Trevett C, Brain T, Gebski V, Corbould A. Glycosylated haemoglobin for screening and diagnosis of gestational diabetes mellitus. BMJ Open 2016 Apr 4; 6(4): e011059
Harper LM, Mele L, Landon MB, et al. Carpenter-Coustan Compared With National Diabetes Data Group Criteria for Diagnosing Gestational Diabetes. Obstet Gynecol 2016; 127:893.
Werner EF, Pettker CM, Zuckerwise L et al. Screening for gestational diabetes mellitus: are the criteria proposed by the International Association of the Diabetes in Pregnancy Study Groups cost-effective? Diabetes Care 2012; 35: 529-535.
Yjmei W, Huixia Y, Weiwei Z, Hongyun Y, Haixia L, Jie Y, Cuiklin Z. International Association of Diabetes and pregnancy Study Group criteria is suitable for gestational diabetes mellitus diagnosis: further evidence from China. Chinese medical Journal 2014; 127: 3553-3556.
Feldman RK, Tieu RS, Yasumara L. Gestational diabetes screening: the IADPSG compared with the Carpentar-Coustan screening. Obstet Gynecol 2016; 127: 10-17.
Mayo K, Melamed N, Vandenberghe H, Berger H. The impact of adoption of the International Association of Diabetes in Pregnancy Study Group criteria for the screening and diagnosis of gestational diabetes. Am J Obstet Gynecol 2015: 212: 224e1-9.
McIntyre HD, Sacks DA, Barbour LA, Feig D, Catalano PM, Damm P, McElduff A. Issues with the diagnosis and classification of hyperglycemia in early pregnancy. Diabetes Care 2016;39: 53-54
Screen Test women with gestational diabetes mellitus for persistent diabetes at 64–12 weeks postpartum, using the oral glucose tolerance test and clinically appropriate non-pregnancy diagnostic criteria. E / Per Dr. Coustan: “This comes from the chapter on management in pregnancy. The recommendation for doing the post partum OGTT at 6-12 weeks post partum is, to my knowledge, unencumbered by data. Rather it is informed by custom. In fact, most obstetricians see their patients at 6 weeks post partum. We recommend scheduling the test just before the post partum checkup so that the results can be discussed with the patient, and if the patient did not attend the test it can be rescheduled. I’ll try to craft some verbiage into the narrative in the treatment chapter about this.” / Reference added to narrative:
McIntyre HD, Sacks DA, Barbour LA, Feig D, Catalano PM, Damm P, McElduff A. Issues with the diagnosis and classification of hyperglycemia in early pregnancy. Diabetes Care 1026;39: 53-54
Women with a history of gestational diabetes mellitus should have lifelong screening for the development of diabetes or prediabetes at least every 3 years. B / No Change Recommended / Not specifically discussed in this section – Readers referred to “Management of Diabetes in Pregnancy” section
Women with a history of gestational diabetes mellitus found to have prediabetes should receive intensive lifestyle interventions or metformin to prevent diabetes. A / Minor wording change. / Not specifically discussed in this section – Readers referred to “Management of Diabetes in Pregnancy” section
All children diagnosed with diabetes in the first 6 months of life should have immediate genetic testing for neonatal diabetes. AB / Minor wording change and evidence level changed to “A.” / 48,49
Maturity-onset diabetes of the young should be considered in individuals who have mild stable fasting hyperglycemia and multiple family members with diabetes not characteristic of type 1 or type 2 diabetes. E / Delete per edits to following recommendations.
Because a diagnosis of maturity-onset diabetes of the young may impact therapy and lead to identification of other affected family members, consider referring individuals with diabetes not typicalChildren and adults who have diabetes not characteristic of type 1 or type 2 diabetes and that occursring in successive generations (suggestive of an autosomal dominant pattern of inheritance) to a specialist for further evaluationshould have genetic testing for maturity-onset diabetes of the young (MODY). AE / Revised and evidence level changed to “A.” / 48,49