Clinical Guidelines For The Management of Diabetes

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Diabetes is a complex disease that requires continuous medical interventions combined with multifactorial risk-reduction approaches. Self-management education among patients is critical to preventing acute and life-long complications. Read about the history of diabetes here.

Diabetes can be classified into the following categories:

  1. Type 1: This type occurs as a result of the destruction of the autoimmune β -cell leading to insulin deficiency.
  2. Type 2: This type occurs due to the progressive loss of the β-cell. As a result, insulin is secreted in the background of insulin resistance.
  3. Gestational Diabetes Mellitus: This type is often diagnosed in the third or the second trimester of pregnancy.

Diabetes Management Guidelines

Type 1 and 2 diabetes are heterogeneous illnesses in which progression and clinical presentation vary considerably. Therapy can only be determined with the presence of a classification. However, even after diagnosis, some patients are still not determined to be suffering from either type 1 or 2 diabetes.

Although at the onset of diagnosis the exact type is not distinguished, it will be identified with time. Today, the traditional paradigms of type 1 occurring in children and type 2 in adults is no longer viable given that both types can happen in any of the 2 stages.

The hallmark symptoms of type 1 diabetes in children presents with polydipsia/polyuria, while others can present symptoms of diabetic ketoacidosis (DKA). DKA is life threatening for diabetics. When it occurs in adults, it mostly does not present the same symptoms found in children.

Sometimes, type 2 diabetes patients present with DKA. In both type 1 and 2 diabetes, certain factors such as environmental and genetic come into play and may contribute to the progression of the loss of the mass of the β-cell. Hyperglycemia may also set in, causing the patient to be at risk of chronic complications. In type 1, the characterization of the involved pathophysiology is more pronounced than is the case in type 2 diabetes.

For type 1, clinical studies make it clear that first-degree relatives, presenting with a history of type 1 diabetes can help in the prediction of the presence of diabetes or hyperglycemia in a patient. The progression of the disease is determined by the antibody titer, the age at which it was diagnosed, antibody specificity, and the number of antibodies.

The 2018 American Diabetes Association pdf gave an updated algorithm on the standards of care. The summary touched on the integration of new technology into the managing diabetes, routine screening in high risk youth for type 2 diabetes, therapeutic approaches that help in the reduction of the onset of complications, and therapeutic approaches for preventing or delaying type 2 diabetes.

Type 2 Diabetes Treatment Guidelines

The ADA is comfortable with the target of glycated hemoglobin (HbA1c) in most patients which is about 7 percent. For young people who do not have a history of cardiovascular disease or hypoglycemia, ADA recommends an HbA1c of not more than 6.5 percent. Adults who have had a history of critical complications and a high hypoglycemia risk could be treated to a target of not more than 8 percent.

These guidelines of care should ensure patients, clinicians; policymakers and researchers get updated components of diabetes, the goals of comprehensive treatment, and quality care. The standard of medical care published also emphasizes glycemic targets.

According to the ADA, the level of pre-prandial plasma glucose should be about 80-130 mg/dl with the peak not exceeding 180 mg/dl. Because there are numerous pharmacologic interventions available, these targets can be met.

The most impactful new guideline is the use of a glucose-lowering agent. This agent has proven cardiovascular benefits including mortality reduction. There is also a recommendation for screening children and adults for prediabetes and type 2 diabetes, especially the obese and those with other risk factors. While maintaining the targets of HnA1c, there are calls to simplify complex regimens and avoid overtreatment.

ADA also gives a guideline for all adults over 18 years with type 1 diabetes to find the need for an expansion of glucose monitoring (CGM) if they do not meet the targeted glycemic.  Some CGMs which now replace finger-testing have so far been approved, with glucose monitoring devises already in effect in the US.

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Diabetes Diet Guidelines

Dietary guidelines released in 2016 for people living with diabetic conditions highlighted the importance of following healthy eating patterns. Nutrient-dense foods such as fruits, vegetables, fat-free dairy, and whole grains can be consumed by diabetics in the recommended amounts. The 2019 revised guidelines on nutrition note that no one-size-fits-all, emphasizing on healthful eating in appropriate portion sizes.

Eating within the recommended portion size improves the health of the patient helping them to attain individualized glycemic, lipid, and blood pressure goals. In turn, this would delay or prevent the onset of type 2 diabetes. Most of the recommendations present in the updated guidelines consist what was highlighted in the 2017 and 2018 editions.

Diabetic patients, according to the guidelines are advised to consume no more than 10 percent of calories each day from added sugars. Diabetes patients are instructed to keep off from added sugars since these are known to cause a spike in blood glucose.

The guidelines also note that healthy eating allows patients to limit the intake of added sugars, sodium, and saturated and Trans fats. Sodium of less than 2300 milligrams is the recommended amount of consumption per day. The dietary guidelines provide a clear roadmap to proper and healthy eating patterns for diabetes patients. Other studies show that the management of a diabetic condition depends on how well a patient balances what they eat and drink and how often they exercise.

The risk of heart disease is nearly doubled among diabetes patients, with a huge chunk of this number being at risk of mental health disorders. Good news is; most type 2 diabetes cases can be prevented, while others can be reversed. Diabetes guidelines published by the American Diabetes Association, with the 2019 standards being the latest are updated annually, allowing clinicians and policymakers to rely on them for advanced diabetic care.