By Eileen B. Wyner, NP
Bulfinch Medical Group
The American Diabetes Association (ADA) publishes guidelines each January to educate professionals about the best clinical practice for people diabetes. I will review the standards that have had changes made in them for 2017. Section 8 (Pharmacologic Approaches to Glycemic Treatment) is a very important section with a great deal of information, so it will be covered in a separate post.
This year the Standards of Care have been updated to address psychosocial issues in all aspects of care. This includes the importance of assessing self-management capabilities, mental health status, and complications and comorbidities. These standards are meant to provide general treatment goals and are not meant to replace clinical judgment. This post is a brief overview of the changes to the standards; click here to access a full list and descriptions. Please remember, that these are in no way meant to replace the individual care that you are participating in with your health care team.
Section 2: Classification and Diagnosis of Diabetes
There is a new consensus on staging Type 1 Diabetes. Three stages have been identified:
- Stage 1 – no changes in the blood glucose values and no symptoms are present
- Stage 2 – some impaired fasting blood glucose and possibly some impaired glucose tolerance, too
- Stage 3 – the stage that most people are diagnosed. They may appear with dangerous hyperglycemia and have symptoms such as excessive thirst, hunger and urination
Investigators hope to use this staging system as a research road map to help better plan intervention strategies.
Dentists are also are important in identifying people with diabetes. One study shows 30% of people over 30 that are treated for periodontal disease have abnormal glucose levels. Educating dentists to refer these individuals to their health care providers for formal assessment will be helpful in identifying at-risk people sooner.
Birth weight of infants is no longer a risk factor for Type 2 Diabetes. Women who had gestational diabetes should have their fasting glucose test done 4 to 12 weeks after having their baby (instead of 6 to 12 weeks). The hope is that most women will have the test done before the 6 week checkup so they can discuss results and implications with their provider.
Section 3: Comprehensive Medical Evaluation and Assessment of Comorbidities
This is a new section highlighting screening for, and management of, comorbid conditions in people with diabetes. Assessment of sleep pattern and duration has been added as well as HIV, autoimmune diseases, depression and anxiety, and disordered eating patterns. Please refer to the full standards to see the entire list of conditions.
Section 4: Lifestyle Management
People following a flexible rapid acting insulin schedule should work closely with a registered dietician for education on counting fat and protein values as well as carbohydrates to be sure they are using correct insulin amounts.
Sitting is the new smoking! Stand up and move a little every 30 minutes. Aim for 150 minutes of exercise per week and try to do strength training 2 to 3 times a week. Balance and flexibility are priorities for older adults, and activities like yoga or Tai Chi are recommended. There is also a table providing information about situations that may require referral to a mental health professional.