type 2 diabetes management guidelines

h޴Wmo�6�+��bh��D� E �nҠq��24֦c��It��n��Pt��yx��L Subsequent antibiotic regimens may be modified with reference to bacteriology and clinical response, Suspected Charcot neuroarthropathy of the foot is an emergency and should be referred immediately to the multidisciplinary foot team, Patients with active diabetic foot disease should be referred to a multidisciplinary diabetic foot care service, The initial treatment of diabetic peripheral neuropathy (DPN) is dependent on individual patient choice, dosing regimens, cost and side-effect profile, Consider antidepressants or anticonvulsants for treatment of painful DPN. ... 2020 Cost-effectiveness of Interventions to Manage Diabetes. This site is intended for UK healthcare professionals, Guidelines Live 2020—now available on demand, Pharmacological management of glycaemic control in people with type 2 diabetes, NICE guideline on acute coronary syndromes, PHE influenza immunisation 2020/21 guideline, KDIGO guideline on diabetes management in CKD, NHS guideline for delivering diabetes care during COVID-19, PCDE pharmacological management of type 2 diabetes, The presence of diabetic symptoms (polyuria, polydipsia, and unexplained weight loss) plus, plasma glucose ≥11.1 mmol/l at 2 hours after a 75g oral glucose load (OGTT), People with diabetes should be offered lifestyle interventions based on a valid theoretical framework, Computer-assisted education packages and telephone prompting should be considered as part of a multidisciplinary lifestyle intervention programme, Healthcare professionals should receive training in patient-centred interventions in diabetes, Structured education programmes should adhere to the principles laid out by the Patient Education Working Group, Adults with type 2 diabetes should have access to structured education programmes based upon adult learning theories, Children and adolescents should have access to programmes of structured education which have a basis in enhancing problem solving skills, Children and adults with type 2 diabetes should be offered psychological interventions (including motivational interviewing, goal setting skills and CBT) to improve glycaemic control in the short and medium term, Healthcare professionals working with adults and children with diabetes should refer those with significant psychological problems to services or colleagues with expertise in this area, Self-monitoring of blood glucose (SMBG)is recommended for patients with type 2 diabetes who are using insulin where patients have been educated in appropriate alterations in insulin dose, Routine SMBG in people with type 2 diabetes is not recommended, Routine self-monitoring of urine glucose in people with type 2 diabetes is not recommended. Anti-hyperglycemic therapy 3. References (11) 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. (SIGN Guidelines No. Subgroup Guidance (9) 7. Stratification (7) 5. Pharmacotherapy Algorithm (8) 6. )�8SB��H�8&!J��IA��f�T��8�dU.�B!��QȥH��E$a�TS�cg��F%�$�^P�Q�R��$K�c�9�a�"V(�HȣP"��rJ�1�R"�Hk��5z/�-�pΗS�s+^��#*�T�z�[/ǃz�0 ��!וGEiN��W��r�^�RF��~�ȴv��iq�f�ӑ��p4��u37%�{BH8��4�C�`��YZ M�M+��7��d䍷06�W/��GXΝۓƬ��{��1U�0��ƫ��y��0�Q?�4Z�S^.��l9wU�:�UDQ�CA��R�_) (SIGN Guidelines No. �H �ޔnܫnK+$��.�$l)�҄��ut��U�>3d��*6C��pM��, �=J��Lg��O5Qa 3. Diabetes management should take place in general practice 4/6 monthly Triage for Desmond • If HbA 1c < 8.0% / 64 mmol/mol - Routine DESMOND appointment • If HbA 1c 8.0 - 9.9% / 64 - 85 mmol/mol - DESMOND in 3/12 • If HbA c> 10% / 86 mmol/mol - DESMOND in 2-3 /52. 1. The 2017 SEMDSA Guideline for the Management of Type 2 Diabetes Guideline Committee. Sulphonylureas should be considered as first-line oral agents in people who are intolerant of, or have contraindications to, metformin 2. Your pancreas makes more insulin to try to get cells to respond. Type 2 diabetes: Goals for optimum management Encourage all people with type 2 diabetes to approach/reach these goals Diet Advise eating according to Australian dietary guidelines, with attention to quantity and type of food If concerns are held regarding cardiovascular disease (CVD) risk, advise individual dietary review ESC Clinical Practice Guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on Diabetes / Pre-Diabetes and Cardiovascular Diseases. The Scottish Intercollegiate Guidelines Network (SIGN) has updated its guidelines on blood sugar control for people with type 2 diabetes. Practice Guidelines Resources. The newly published document states people with type 2 diabetes should […] SIGN 154: Pharmacological management of glycaemic control in people with type 2 diabetes provides recommendations on: These guidelines provide recommendations based on current evidence for best practice in the management of diabetes. Weight loss 2. Department of Defense . Sulphonylureas should be considered as add-on second-line treatment to other oral therapies and may be useful in triple oral therapy 3. The onset of Type 2 diabetes is subtle and early detection in general practice requires clinical suspicion combined with systematic and opportunistic case-finding, as diagnosis is frequently delayed until complications appear. The ADA guidelines still recommend Metformin as the first drug for patients with diabetes type 2 (DM2). Patients with diabetes requiring antihypertensive treatment should be commenced on: an angiotensin-converting enzyme [ACE] inhibitor (angiotensin receptor blockers [ARB] if ACE inhibitor intolerant), Beta blockers and alpha blockers should not normally be used in the initial management of blood pressure in patients with diabetes, Low-dose aspirin is not recommended for primary prevention of vascular disease in patients with diabetes, Lipid-lowering drug therapy with simvastatin 40 mg or atorvastatin 10 mg is recommended for primary prevention in patients with type 2 diabetes aged >40 years regardless of baseline cholesterol, Intensive insulin treatment to be continued for at least 24 hours in patients with myocardial infarction, Treat patients with an ST elevation immediately with primary percutaneous coronary intervention, When primary percutaneous coronary intervention cannot be provided within 90 minutes of diagnosis, patients with an ST elevation acute coronary syndrome should receive immediate thrombolytic therapy, Long term aspirin (75 mg per day) should be given routinely. Read the Guidelines in Practice article Type 2 diabetes: what are the benefits and risks of glucose-lowering agents? Management of Diabetes Mellitus in Primary Care (2017) The guideline describes the critical decision points in the Management of Diabetes Mellitus (DM) and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. 2020 Diabetes Self-management Education and Support in Adults With Type 2 Diabetes. Possibly, diabetes medication or insulin therapy 5. Patient-centered care 2. If the HbA, Aim to optimise insulin dose and regimen to achieve target glycaemia while minimising the risk of hypoglycaemia and weight gain, Soluble human insulin or rapid-acting insulin analogues can be used when intensifying insulin regimens to improve or maintain glycaemic control, Follow lifestyle modification recommendations on, Follow recommendations for glycaemic control in type 2 diabetes, Hypertension in people with diabetes should be treated aggressively with lifestyle modification and drug therapy, Target diastolic blood pressure in people with diabetes is ≤80 mmHg, Target systolic blood pressure in people with diabetes is <130 mmHg. If you have type 2 diabetes, cells don’t respond normally to insulin; this is called insulin resistance. Each aspect of care is outlined to include screening for diabetes and its complications and management of hyperglycaemia with drug therapy. Eventually your pancreas can’t keep up, and your blood sugar rises, setting the stage for prediabetes and type 2 diabetes. Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes. Scottish Intercollegiate Guidelines Network, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB (Tel – 0131 623 4720), www.sign.ac.uk/sign-116-and-154-diabetes.html, Scottish Intercollegiate Guideline Network. Edinburgh: SIGN; 2017. SMBG may be considered in the following groups of people with type 2 diabetes who are not using insulin: those undergoing significant changes in pharmacotherapy or fasting, for example, during Ramadan, those with unstable or poor glycaemic control (HbA, those who are pregnant or planning pregnancy, Offer obese adults with type 2 diabetes individualised interventions to encourage weight loss (including lifestyle, pharmacological or surgical interventions) to improve metabolic control, Advise all people who smoke to stop and offer support to help facilitate this to minimise cardiovascular and general health risks, Offer intensive management plus pharmacological therapies to people with diabetes who wish to stop smoking, Healthcare professionals should continue to monitor smoking status in all patient groups, All people should be advised to increase their level of physical activity to achieve current physical activity recommendations and be supported to maintain this level across the lifespan, Exercise and physical activity (involving aerobic and/or resistance exercise) should be performed on a regular basis, Advice about exercise and physical activity should be individually tailored and diabetes specific and should include implications for glucose management and foot care, Individualised advice on avoiding hypoglycaemia when exercising by adjustment of carbohydrate intake, reduction of insulin dose, and choice of injection site, should be given to patients taking insulin, People with existing complications of diabetes should seek medical review before embarking on exercise programmes, A gradual introduction and initial low intensity of physical activity with slow progressions in volume and intensity should be recommended for sedentary people with diabetes, People with type 2 diabetes can be given dietary choices for achieving weight loss that may also improve glycaemic control. Department of Veterans Affairs . Drug Classes (10) 8. Guidelines of this nature are written to direct and inform and may not be suitable for application to all patients in Dudley. Risk factors for peripheral arterial disease include: Risk factors for foot ulceration include: peripheral arterial disease and peripheral neuropathy, All patients with diabetes should be screened to assess their risk of developing a foot ulcer, The result of a foot screening examination should be entered onto an online screening tool, such as SCI-DC, to provide automatic risk stratification and a recommended management plan, including patient information, Foot care education is recommended as part of a multidisciplinary approach in all patients with diabetes, Treatment of a patient with an infected diabetic foot ulcer and/or osteomyelitis should be commenced immediately with an antibiotic in accordance with local or national protocols. QUALIFYING STATEMENTS . It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose They should be essential in everyday clinical decision making. Lifestyle Change Programs to Prevent Type 2 Diabetes. Other considerations American Diabetes Association. Healthy eating 3. Being physically active is very important in preventing or handling type 2 diabetes. All others should be screened at least annually, Use retinal photography or slit lamp biomicroscopy, Retinal photographs should be graded using digital images by an appropriately trained grader, type 2 diabetes with new vessels at the disc or iris, new vessels elsewhere with vitreous haemorrhage, type 2 diabetes and new vessels elsewhere, Patients with severe or very severe non-proliferative diabetic retinopathy should receive close follow-up or laser photocoagulation, Patients with tractional retinal detachment threatening the macula, Vitrectomy should be considered for severe fibrovascular proliferation, Cataract extraction should not be delayed, Cataract extraction is advised when sight-threatening retinopathy cannot be excluded, Community support, maximising disability benefits, low vision aids and training in their use should be provided to people with diabetes and visual impairment. For grownups who are 19-64 years of age, the government advises a minimum of: 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity– such as biking or vigorous walking– a week, which can be taken in sessions of 10 minutes or more, and This succinct summary highlights the treatment recommendations for type 2 diabetes by cardiovascular/renal disease or risk factor. What’s New in 2020 First, additional agents approved for use in Canada have been shown to have cardiovascular (CV) beneﬁts in patients with type 2 diabetes. Diagnosis of Diabetes Referral to Beaumont Diabetes Service Diagnosis of Type 2 Diabetes 2 This guideline covers the care and management of type 2 diabetes in adults (aged 18 and over). Your Type 2 Diabetes Management Guideline September 3, 2018 No Comments The goals of my Type 2 diabetes management guideline are to control your blood glucose levels and to screen and treat its related conditions such as high blood pressure, lipid abnormalities, high cholesterol, and other complications of diabetes. Blood sugar monitoringThese steps will help keep your blood sugar level closer to normal, which can delay or prevent complications. Education Recognition Program. ��zU��7�ZZ*�^G,+'eO��O�Oy��C��V^:��Y��v�E��L3��0�7p'�N��h9.�\�g0��0�˺¿� X�>��z��-�`�Z�l�B s��r�-5��,�w��S��ꂅm\=��e�-kY The IDF Life for a Child Programme and ISPAD decided it was appropriate to develop a shortened version of these guidelines aimed to be of practical use in emergency situations and in clinics that are developing expertise in managing diabetes in children. This algorithm for the comprehensive management of persons with type 2 diabetes (T2D) was developed to provide clinicians with a practical guide that considers the whole patient, his or her spectrum of risks and complications, and evidence-based approaches to treatment. Diabetes, Prevention and Management of Associated Complications (11) 9. Implementation strategies 4. The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. … Read about our cookies here.. The benefits and risks of continuing other glucose-lowering agents should also be reviewed at this time on an individualised basis, Once-daily bedtime neutral protamine hagedorn (NPH) insulin should be used when adding insulin to metformin. .�O�à��Dn9�s�&~�'�Z��,��E�Ἔ��L�l�u�� ~$=��&�H��3��L&"UJhDx��i,�Iӌ�s�G�L��d_��5RQ�G��3i�g4��;�;�/t(g�[))�~?Z |n��Xx�o�wb9DG��Ҵ3&. 13, “Pharmacologic Glycemic Management of Type 2 Diabetes in Adults” (1). Options include simple caloric restriction, reducing fat intake, consumption of carbohydrates with low rather than high glycaemic index, and restricting the total amount of dietary carbohydrate (a minimum of 50 g per day appears safe for up to 6 months), Overweight individuals and those at high risk of developing diabetes should be encouraged to reduce this risk by lifestyle changes including weight management and physical activity, Clinical interventions aimed at dietary change are more likely to be successful if a psychological approach based on a theoretical framework is included, People with diabetes can take alcohol in moderation as part of a healthy lifestyle but should aim to keep within the target consumption recommended for people without diabetes, Metformin should be considered as the first-line oral treatment option for people with type 2 diabetes, Sulphonylureas should be considered as first-line oral agents in people who are intolerant of, or have contraindications to, metformin, Sulphonylureas should be considered as add-on second-line treatment to other oral therapies and may be useful in triple oral therapy, Sulphonylurea therapy is associated with hypoglycaemia (caution should be taken in the elderly) and weight gain, Pioglitazone should be considered, usually as dual or triple therapy, for lowering HbA, Pioglitazone should not be used in patients with heart failure, The risk of fracture should be considered during long-term use of pioglitazone, Patients prescribed pioglitazone should be made aware of the increased risk of peripheral oedema, heart failure, weight gain, bladder cancer, and fractures, DPP-4 inhibitors should be considered, usually as dual or triple therapy, for lowering HbA, SGLT2 inhibitors should be considered as an add-on therapy to metformin in people with type 2 diabetes, In individuals with type 2 diabetes and established cardiovascular disease, SGLT2 inhibitors with proven cardiovascular benefit (currently empagliflozin and canagliflozin) should be considered, GLP-1 receptor agonist therapy should be considered in people with a body mass index of ≥30 kg/m, GLP-1 receptor agonist therapy should be considered as an alternative to insulin in people for whom treatment with combinations of oral glucose-lowering drugs has been inadequate, For individuals with type 2 diabetes and established cardiovascular disease, GLP-1 receptor agonist therapies with proven cardiovascular benefit (currently liraglutide) should be considered, Oral metformin therapy should be continued when insulin therapy is initiated to maintain or improve glycaemic control, Consider stopping or reducing sulphonylurea therapy when insulin therapy is initiated. Click here to access the corresponding chapter in ESC CardioMed - Section 19 Diabetes mellitus and metabolic syndrome Recommendations on comprehensive care, glycaemic monitoring and targets, lifestyle and antihyperglycaemic interventions, and approaches to self-management and optimal models of care, This NHS guidance for general practice covers the key points of delivering diabetes care during the challenging times of the COVID-19 pandemic. In a bid to improve the standard of healthcare for people in Scotland, SIGN has issued advice for doctors and nurses on drug management. This Guidelines summary covers key information on expansion of the 2020-21 flu immunisation programme. , consider a frequency of every 3 years using either fasting plasma glucose or.. Have type 2 diabetes in childhood and adolescence in under-resourced countries, 2nd edition recommendations from SIGN 154 the...: the Society for Endocrinology, Metabolism and diabetes of South Africa type 2 diabetes, and. 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