Οι Νέες Οδηγίες για το Διαβήτη 2018 από την American Diabetes Association

Δημοσιεύτηκαν οι νέες συστάσεις για τον Σακχαρώδη Διαβήτη  – 2018 από την Αμερικανική Διαβητολογική Εταιρεία (ADA) »»

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The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge. With annual updates since 1989, the American Diabetes Association’s (ADA’s) “Standards of Medical Care in Diabetes” (Standards of Care) has long been a leader in producing guidelines that capture the most current state of the field. Starting in 2018, the ADA will update the Standards of Care even more frequently online should the Professional Practice Committee determine that new evidence or regulatory changes merit immediate incorporation into the Standards of Care. In addition, the Standards of Care will now become the ADA’s sole source of clinical practice recommendations, superseding all prior position and scientific statements. The change is intended to clarify the Association’s current positions by consolidating all clinical practice recommendations into the Standards of Care.


Section 8. Pharmacologic Approaches to Glycemic Treatment

New recommendations for antihyperglycemic therapy for adults with type 2 diabetes have been added to reflect recent cardiovascular outcomes trial (CVOT) data, indicating that people with atherosclerotic cardiovascular disease (ASCVD) should begin with lifestyle management and metformin and subsequently incorporate an agent proven to reduce major adverse cardiovascular events and/or cardiovascular mortality after considering drug-specific and patient factors.

The algorithm for antihyperglycemic treatment (Fig. 8.1) was updated to incorporate the new ASCVD recommendation.

A new table was added (Table 8.1) to summarize drug-specific and patient factors of antihyperglycemic agents. Figure 8.1 and Table 8.1 are meant to be used together to guide the choice of antihyperglycemic agents as part of patient–provider shared decision-making.

Table 8.2 was modified to focus on the pharmacology and mechanisms of available glucose-lowering medicines in the U.S.

To provide a second set of cost information for antihyperglycemic agents, NADAC data was added to the average wholesale prices information in Table 8.3 and Table 8.4.

Section 9. Cardiovascular Disease and Risk Management

A new recommendation was added that all hypertensive patients with diabetes should monitor their blood pressure at home to help identify masked or white coat hypertension, as well as to improve medication-taking behavior.

A new figure (Fig. 9.1) was added to illustrate the recommended antihypertensive treatment approach for adults with diabetes and hypertension.

A new table (Table 9.1) was added summarizing studies of intensive versus standard hypertension treatment strategies.

A recommendation was added to consider mineralocorticoid receptor antagonist therapy in patients with resistant hypertension.

The lipid management recommendations were modified to stratify risk based on two broad categories: those with documented ASCVD and those without.

Owing to studies suggesting similar benefits in older versus middle-aged adults, recommendations were consolidated for patients with diabetes 40–75 years and >75 years of age without ASCVD to use moderate-intensity statin.

Table 9.2 (“Recommendations for statin and combination treatment in adults with diabetes”) was updated based on the new risk stratification approach and consolidated age-groups.

To accommodate recent data on new classes of lipid-lowering medications, a recommendation was modified to provide additional guidance on adding nonstatin LDL-lowering therapies for patients with diabetes and ASCVD who have LDL cholesterol ≥70 mg/dL despite maximally tolerated statin dose.

The same recommendations were added here as in Section 8 that people with type 2 diabetes and ASCVD should begin with lifestyle management and metformin and subsequently incorporate an agent proven to reduce major adverse cardiovascular events and/or cardiovascular mortality after considering drug-specific and patient factors.

The text was substantially modified to describe CVOT data on new diabetes agents and outcomes in people with type 2 diabetes, providing support for the new ASCVD recommendations.

A new Table 9.4 was added to summarize the CVOT studies.

Section 10. Microvascular Complications and Foot Care

A new table was added (Table 10.1), replacing previous tables 10.1 and 10.2, that combines information on staging chronic kidney disease and the appropriate kidney-related care for each stage.

A new Table 10.2 was included describing the complications of chronic kidney disease and related medical and laboratory evaluations.

A new section on acute kidney injury was included.

The effect of specific glucose-lowering medications on the delay and progression of kidney disease was discussed, with reference to recent CVOT trials that examined kidney effects as secondary outcomes.

A new recommendation was added on the noninferiority of the anti–vascular endothelial growth factor treatment ranibizumab in reducing the risk of vision loss in patients with proliferative diabetic retinopathy when compared with the traditional standard treatment, panretinal laser photocoagulation therapy.

A new section was added describing the mixed evidence on the use of hyperbaric oxygen therapy in people with diabetic foot ulcers.

Σπύρος Καραμαγκιώλης – Διαβητολόγος
Αγρίνιο Λάρισα Διαβητικό Πόδι

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