Diabetes Journal Club Carina Signori Endocrinology Fellow Objectives

Diabetes Journal Club Carina Signori Endocrinology Fellow

Objectives � 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 A 1 C ≥ 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

12 Change Physical Activity New Addition

Hypertension 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.

Transition from Peds to Adult � 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 midadolescence 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)

Cystic Fibrosis-related diabetes (CFRD) � 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 A 1 C 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)

Strategies for improving Care � � 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)

Questions?