B, 10.47 Treatment of patients with HFrEF should include a -blocker with proven CV outcomes benefit, unless otherwise contraindicated. 12.1 Optimize glycemic control to reduce the risk or slow the progression of diabetic retinopathy. Methods: We examined the frequency . Goals should be individualized based on duration of diabetes, age/life expectancy, comorbid conditions, known CVD or advanced microvascular complications, hypoglycemia unawareness, and individual patient considerations. 13.11 Optimal nutrition and protein intake is recommended for older adults; regular exercise, including aerobic activity, weight-bearing exercise, and/or resistance training, should be encouraged in all older adults who can safely engage in such activities. B, 8.12 There is no clear evidence that dietary supplements are effective for weight loss. Interactive strategies that facilitate communication between providers and patients appear more effective. C. Hyperglycemia in hospitalized patients is defined as blood glucose levels >140 mg/dL (7.8 mmol/L). Click on image below to view the idf 2022 image gallery Our partners Supporting companies and organisations 4.10 Patients with type 2 diabetes or prediabetes and elevated liver enzymes or fatty liver on ultrasound should be evaluated for presence of nonalcoholic steatohepatitis and liver fibrosis. C. Patients with or without diabetes may experience hypoglycemia in the hospital setting. See Table 13.1 for treatment goal framework. A, 10.39 Aspirin therapy (75162 mg/day) may be considered as a primary prevention strategy in those with diabetes who are at increased CV risk, after a comprehensive discussion with the patient on the benefits versus the comparable increased risk of bleeding. 10. For appropriate context, see Figure 4.1. %CV, percentage coefficient of variation; TAR, time above range; TBR, time below range. SGLT2 inhibitors should be given to all patients with stage 3 CKD or higher and type 2 diabetes regardless of glycemic control, as they slow CKD progression and reduce HF risk independent of glycemic control. A. A, 10.48 In patients with type 2 diabetes with stable HF, metformin may be continued for glucose lowering if eGFR remains >30 mL/min/1.73 m2 but should be avoided in unstable or hospitalized patients with HF. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities, 4. Standardized CGM Metrics for Clinical Care. 13.3 Screening for early detection of mild cognitive impairment or dementia should be performed for adults 65 years of age or older at the initial visit and annually as appropriate. This article takes a critical look at the possible effects when regular exercise and carbohydrate restriction are combined. [from 19th c.] 2020, Ian Sample, The Guardian, 7 September: In the UK, one in 10 people over 40 live with type 2 diabetes, while one in four . This guideline represents an update of the first guideline and extends the evidence base by including new studies and treatments which have emerged since the original guideline was produced in 2005. TBR: % of readings and time 5469 mg/dL (3.03.8 mmol/L), 10. B, 16.2 Insulin should be administered using validated written or computerized protocols that allow for predefined adjustments in the insulin dosage based on glycemic fluctuations. Studies show HF (with preserved ejection fraction [HFpEF] or reduced ejection fraction [HFrEF]) is twofold higher in people with diabetes compared to those without. E, 8.20 People being considered for metabolic surgery should be evaluated for comorbid psychological conditions and social and situational circumstances that have the potential to interfere with surgery outcomes. 11/19/2022 ISPAD News 11/2022 . La Gua, dirigida a profesionales de la salud, est desarrollada para sistematizar prcticas educativas basadas en evidencia, para promover, conservar y recuperar la salud de las personas con diabetes con el propsito de reducir y minimizar complicaciones agudas y crnicas que podran presentarse; y establecer contenidos bsicos que debe abarcar un programa de educacin dirigido a personas con diabetes. E, 7.2 When prescribing a device, ensure that people with diabetes/caregivers receive initial and ongoing education and training, either in-person or remotely, and regular evaluation of technique, results, and their ability to use data, including uploading/sharing data (if applicable), to adjust therapy. The IDF School of Diabetes is pleased to present a new free online course that provides the latest advanced guidelines on the availability of affordable insulin options and the effective use of biosimilar to prevent damages in diabetes management and promote self-management. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes, 9. A, 10.11 Multiple-drug therapy is generally required to achieve blood pressure targets. All chapters in these guidelines have been provided with formation to reflect advances in scientific knowledge and clinical care that have occurred in the recent past. provides scientific guidelines for the prevention of major noncommunicable diseases including diabetes; develops norms and standards for diabetes diagnosis and care; builds awareness on the global epidemic of diabetes, marking World Diabetes Day (14 November); and conducts surveillance of diabetes and its risk factors. B, 6.7 Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with limited life expectancy or where the harms of treatment are greater than the benefits. Discharge planning should begin at admission and be updated as patient needs change. A, 10.45 In patients with known ASCVD, particularly CAD, ACE inhibitor or ARB therapy is recommended to reduce the risk of CV events. Type 2 diabetes in youth has increased over the past 20 years, and recent estimates suggest an incidence 5,000 new cases per year in the United States. C, 5.31 Flexibility training and balance training are recommended 23 times/week for older adults with diabetes. Now is the time to learn more about gestational diabetes, Management of gestational diabetes in the community. B, 15.22 Insulin resistance decreases dramatically immediately postpartum, and insulin requirements need to be evaluated and adjusted, as they are often roughly half the prepregnancy requirements for the initial few days postpartum. #CGM may be used to assess glycemic target as noted in Recommendation 6.5b and Figure 6.1. The ADA position statements Type 1 Diabetes in Children and Adolescents and Evaluation and Management of Youth-Onset Type 2 Diabetes provide additional information. 5.40 Routinely monitor people with diabetes for diabetes distress, particularly when treatment targets are not met and/or at the onset of diabetes complications. 8.19 Metabolic surgery should be performed in highvolume centers with multidisciplinary teams knowledgeable about and experienced in the management of obesity, diabetes, and gastrointestinal surgery. It can be helpful to understand what exactly glucose is. Use language that is person-centered (e.g., person with diabetes is preferred over diabetic). The International Diabetes Federation (IDF) is an umbrella organization of over 230 national diabetes associations in 170 countries and territories. The International Diabetes Federation (IDF) is an umbrella organization of over 230 national diabetes associations in 170 countries and territories. Criteria for the Screening and Diagnosis of Prediabetes and Diabetes. Although concerns have been raised regarding a potential adverse impact of lipid-lowering agents on cognitive function, several lines of evidence point against this association. IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group's Criteria Diabetes Res Clin Pract. A, 12.21 Perform a comprehensive foot evaluation at least annually to identify risk factors for ulcers and amputations. 7.12 rtCGM A or isCGM C can be used for diabetes management in adults with diabetes on basal insulin who are capable of using devices safely (either by themselves or with a caregiver). B, 13.5 For older adults with type 1 diabetes, CGM should be considered to reduce hypoglycemia. A, 9.4b Other medications (glucagon-like peptide 1 [GLP-1] receptor agonists, sodiumglucose cotransporter 2 [SGLT2] inhibitors), with or without metformin based on glycemic needs, are appropriate initial therapy for individuals with type 2 diabetes with or at high risk for atherosclerotic cardiovascular disease (ASCVD), HF, and/or chronic kidney disease (CKD) (Figure 9.3). International diabetes federation-Diabetes and Ramadan (IDF-DAR) 2021 established guidelines for doctors to categorize patients who intend to fast during Ramadan based on status of glycemic. Available to download and to order in print format. A, 4.4 A follow-up visit should include most components of the initial comprehensive medical evaluation (see Table 4.1 in the complete 2022 Standards of Care). C, 12.26 A multidisciplinary approach is recommended for individuals with foot ulcers and high-risk feet (e.g., dialysis patients and those with Charcot foot or prior ulcers or amputation). Reasons include the size and complexity of the evidence-base, and the complexity of diabetes care itself. 14.63 A reasonable A1C target for most children and adolescents with type 2 diabetes is <7% (53 mmol/mol). A, 5.36 Psychosocial care should be integrated with a collaborative, patient-centered approach and provided to all people with diabetes, with the goals of optimizing health outcomes and health-related quality of life. Managing type 2 diabetes; Diabetic foot; Diabetes in childhood and adolescence; TBR: % of readings and time <54 mg/dL (<3.0 mmol/L), Peak postprandial capillary plasma glucose, Glucose <70 mg/dL (3.9 mmol/L) and 54 mg/dL (3.0 mmol/L), A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia, CGM systems that measure and display glucose levels continuously, CGM systems that measure glucose levels continuously but only display glucose values when swiped by a reader or a smartphone. The 2022 American Diabetes Association (ADA) Standards of Medical Care in Diabetes and the Kidney Disease: Improving Global Outcomes (KDIGO) 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease each provide evidence-based recommendations for management. Another result is diversity of standards of clinical practice. Read more A, 10.16 Intensify lifestyle therapy and optimize glycemic control for patients with elevated triglyceride levels (150 mg/dL [1.7 mmol/L]) and/or low HDL cholesterol (<40 mg/dL [1.0 mmol/L] for men, <50 mg/dL [1.3 mmol/L] for women). These devices are not fully owned by the patientthey are clinic-based devices, as opposed to the patient-owned rtCGM or isCGM CGM devices. B, 13.2 Screen for geriatric syndromes (i.e., polypharmacy, cognitive impairment, depression, urinary incontinence, falls, and persistent pain and frailty) in older adults, as they may affect diabetes self-management and diminish quality of life. A, 5.2 There are four critical times to evaluate the need for diabetes self-management education to promote skills acquisition in support of regimen implementation, MNT, and well-being: at diagnosis, annually and/or when not meeting treatment targets, when complicating factors develop (medical, physical, psychosocial), and when transitions in life and care occur. Drug-Specific and Patient Factors to Consider When Selecting Antihyperglycemic Treatment in Adults With Type 2 Diabetes. See 12. Global Guideline for Type 2 Diabetes Last update: 10/04/2017 In 2005 the first IDF Global Guideline for type 2 diabetes was developed. The Federation has been leading the global diabetes community since 1950. According to the International Diabetes Federation (IDF), approximately 537 million people worldwide have diabetes, and there will be 783 million diabetics worldwide by 2045 1.Over the past three . 1):S144S174, Addendum. This is an abridged version of the current Standards of Care containing the evidence-based recommendations most pertinent to primary care. It may be used together with SGLT2 inhibitors. If tests are normal, repeat testing at a minimum of 3-year intervals, or more frequently if BMI is increasing or risk factor profile deteriorating, is recommended. B, 4.1 A patient-centered communication style that uses person-centered and strength-based language and active listening; elicits patient preferences and beliefs; and assesses literacy, numeracy, and potential barriers to care should be used to optimize patient health outcomes and health-related quality of life. A, Evaluate for diabetes complications and potential comorbid conditions. C, 6.10 Glucose (approximately 1520 g) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate that contains glucose may be used. B, 13.16 Consider costs of care and insurance coverage rules when developing treatment plans in order to reduce risk of cost-related nonadherence. The presence of a single end-stage chronic illness, such as stage 34 HF or oxygen-dependent lung disease, CKD requiring dialysis, or uncontrolled metastatic cancer, may cause significant symptoms or impairment of functional status and significantly reduce life expectancy. B, 8.22 If postbariatric hypoglycemia is suspected, clinical evaluation should exclude other potential disorders contributing to hypoglycemia, and management includes education, MNT with a dietitian experienced in postbariatric hypoglycemia, and medication treatment, as needed. C, 12.28 Provide general preventive foot self-care education to all patients with diabetes. A, 11.4 Optimization of blood pressure control and reduction in blood pressure variability to reduce the risk or slow the progression of CKD is recommended. B, 12.5 If there is no evidence of retinopathy for one or more annual eye exams and glycemia is well controlled, then screening every 12 years may be considered. AClear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered, BSupportive evidence from well-conducted cohort studies, CSupportive evidence from poorly controlled or uncontrolled studies, EExpert consensus or clinical experience. 7.11 Real-time CGM (rtCGM) A or intermittently scanned CGM (isCGM) B should be offered for diabetes management in adults with diabetes on multiple daily injections (MDI) or CSII who are capable of using devices safely (either by themselves or with a caregiver). Refer to sections 10 and 11 in the complete 2022 Standards of Care for detailed discussions of CVD and CKD risk management. Adapted from Davies MJ, DAlessio DA, Fradkin J, et al. Nephrology perspective. A, 9.6 Early combination therapy can be considered in some patients at treatment initiation to extend the time to treatment failure. This is not true in the global context where, although every health-care system seems to be short of resources, the funding and expertise available for health-care vary widely between countries and even between localities. The safety and efficacy of noninsulin glucose-lowering therapies in the hospital setting is an area of active research. It also seeks to highlight the opportunities to strengthen the prevention, diagnosis, and treatment of diabetes. An earlier appointment (in 12 weeks) is preferred, and frequent contact may be needed avoid hyperglycemia and hypoglycemia. Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat to prevent diabetes. 11. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes2022. Better outcomes were reported for DSMES interventions that were >10 hours over the course of 612 months. 4.3 A complete medical evaluation should be performed at the initial visit to: Confirm the diagnosis and classify diabetes. E, 5.38 Providers should consider assessment for symptoms of diabetes distress, depression, anxiety, disordered eating, and cognitive capacities using age-appropriate standardized and validated tools at the initial visit, at periodic intervals, and when there is a change in disease, treatment, or life circumstance. B, 3.9 In adults with overweight/obesity at high risk of type 2 diabetes, care goals should include weight loss or prevention of weight gain, minimizing progression of hyperglycemia, and attention to CV risk and associated comorbidities. B. Therefore, careful management of inpatients with diabetes has direct and immediate benefits. A, 10.42b In patients with type 2 diabetes and established ASCVD or multiple risk factors for ASCVD, a GLP-1 receptor agonist with demonstrated CV benefit is recommended to reduce the risk of MACE. For all three tests, risk is continuous, extending below the lower limit of the range and becoming disproportionately greater at the higher end of the range. Individuals with diabetes must assume an active role in their care. A successful medical evaluation depends on beneficial interactions between the patient and the care team. 10 October 2022 ADEA bids farewell to . ADA Staff are Mindy Saraco, MHA; Malaika I. Hill, MA; Robert A. Gabbay, MD, PhD; and Nuha Ali El Sayed, MD, MMSc. B, 8.21 People who undergo metabolic surgery should receive long-term medical and behavioral support and routine monitoring of micronutrient, nutritional, and metabolic status. Individuals with peripheral neuropathy are at an increased risk of skin breakdown, infection, and Charcot joint destruction with some forms of exercise, due to decreased pain sensation. B, 12.23 Obtain a prior history of ulceration, amputation, Charcot foot, angioplasty or vascular surgery, cigarette smoking, retinopathy, and renal disease and assess current symptoms of neuropathy (pain, burning, numbness) and vascular disease (leg fatigue, claudication). Important changes coming to Diabetes grant matching funds requirement July 1, 2021. The IDF School of Diabetes is pleased to present a new free online course that provides the latest advanced guidelines on the availability of affordable insulin options and the effective use of biosimilar to prevent damages in diabetes management and promote self-management. CVOT, cardiovascular outcomes trial; DPP-4i, dipeptidyl peptidase 4 inhibitor; GLP-1 RA, glucagon-like peptide 1 receptor agonist; SGLT2i, sodiumglucose cotransporter 2 inhibitor; SU, sulfonylurea; TZD, thiazolidinedione. A, 15.2 Family planning should be discussed, and effective contraception (with consideration of long-acting, reversible contraception) should be prescribed and used until a woman's treatment regimen and A1C are optimized for pregnancy. E, 16.10 For individual patients, treatment regimens should be reviewed and changed as necessary to prevent further hypoglycemia when a blood glucose value of <70 mg/dL (3.9 mmol/L) is documented. B, 10.5 For individuals with diabetes and hypertension at lower risk for CVD (10-year ASCVD risk <15%), treat to a blood pressure target of <140/90 mmHg. Back . E, 13.18 Patients with diabetes residing in LTC facilities need careful assessment to establish individualized glycemic goals and to make appropriate choices of glucose-lowering agents based on their clinical and functional status. B If one class is not tolerated, the other should be substituted. B, 15.27 Women with a history of GDM should seek preconception screening for diabetes and preconception care to identify and treat hyperglycemia and prevent congenital malformations. Dilated eye examinations should occur ideally before pregnancy or in the first trimester, and then patients should be monitored every trimester and for 1 year postpartum as indicated by the degree of retinopathy and as recommended by the eye care provider. Diabetes Care 2017;40:16221630. A, 10.44 For patients with type 2 diabetes and CKD treated with maximum tolerated doses of ACE inhibitors or ARBs, addition of finerenone should be considered to improve CV outcomes and reduce the risk of CKD progression. ADL, activities of daily living. A, 10.7 For patients with blood pressure >120/80 mmHg, lifestyle intervention consists of weight loss when indicated, a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern, including reducing sodium and increasing potassium intake, moderation of alcohol intake, and increased physical activity. 7.15 In patients on MDI and CSII, rtCGM devices should be used as close to daily as possible for maximal benefit. The Federation has been leading the global diabetes community since 1950. Classification and Diagnosis of Diabetes, 3. A, 10.24 For patients with diabetes and ASCVD considered very high risk using specific criteria, if LDL cholesterol is 70 mg/dL on maximally tolerated statin dose, consider adding additional LDL-lowering therapy (such as ezetimibe or PCSK9 inhibitor). J. Over one-fourth of people >65 years of age have diabetes, and one-half of older adults have prediabetes. E. Table 6.2 summarizes CGM-derived glycemic metrics, and Table 7.3 defines the available types of CGM devices. Sections 10 and 11 have been updated to include evidence from trials of medication effects in patients with type 2 diabetes on heart failure, cardiovascular, and chronic kidney disease outcomes, including EMPEROR-Preserved, PRESERVED-HF, FIDELIO-DKD, and FIGARO-DKD, and to remove information associated with the discontinued trial PROMINENT. A, 10.9 Patients with confirmed office-based blood pressure 160/100 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single-pill combination of drugs demonstrated to reduce CV events in patients with diabetes. If oral medications are withheld in the hospital, there should be a protocol for resuming them 12 days before discharge. Modest weight loss improves glycemic control and reduces the need for glucose-lowering medications, and more intensive dietary energy restriction can substantially reduce A1C and fasting glucose and promote sustained diabetes remission through at least 2 years. Impact of a Pharmacist-Led Diabetes Care Service for Hispanic Patients at a Free Medical Clinic, Personalized Virtual Care Using Continuous Glucose Monitoring in Adults With Type 2 Diabetes Treated With Less Intensive Therapies, Severe Hypoglycemia and the Use of Glucagon Rescue Agents: An Observational Survey in Adults With Type 1 Diabetes, Human Insulin as an Antidote to the High Cost of Insulin: Clinical Insignificance of Pharmacokinetic/Pharmacodynamic Differences, 1. B, 10.15 Lifestyle modification focusing on weight loss (if indicated); application of a Mediterranean style or DASH eating pattern; reduction of saturated fat and trans fat; increase of dietary n-3 fatty acids, viscous fiber, and plant stanols/sterols intake; and increased physical activity should be recommended to improve the lipid profile and reduce the risk of developing ASCVD in patients with diabetes. The Guide, targeted at health professionals, aims to standardise evidence-based educational practices to improve the health of people with diabetes by reducing the risk of acute and chronic complications; and establishing basic content to be included in education programmes for people with diabetes. The new IDF Clinical Practice Recommendations for managing Type 2 Diabetes in Primary Care seek to summarise current evidence around optimal management of people with type 2 diabetes. 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