Magazine article Drug Topics

Clinical Updates on Diabetes Care

Magazine article Drug Topics

Clinical Updates on Diabetes Care

Article excerpt


Diabetes care is constantly evolving over time as new data emerge. It is crucial to stay informed of most up-to-date evidence to provide optimal diabetes care. With the reputable guidelines and data, this article provides an overview of the updates in diabetes care, including obesity management, glycemic control goals, antihyperglycemic pharmacotherapy, cardiovascular risk modifications, and review of new antidiabetic agents.

Comprehensive diabetes care is an extremely complex task that takes an entire team of healthcare professionals to work together to provide optimal, multidisciplinary care for patients with diabetes. It is important for healthcare professionals and patients to understand that type 2 diabetes mellitus is a progressive condition and that it is normal to add and intensify therapy over time. The experience and knowledge from pertinent clinical studies highlight the importance of individualized therapy for patients with diabetes. As the range of treatment options for diabetes expands, healthcare professionals need to learn and practice the art of diabetes care.

Obesity management

The American Association of Clinical Endocrinologists (AACE) recently published the new Comprehensive Diabetes Management Algorithm in the spring of 2013.1 The AACE starts this algorithm by emphasizing the management of obesity. According to the Centers for Disease Control and Prevention, more than one-third of adults (35.7%) in the United States are obese, and their medical costs are over $1400 higher than those of normal weight.2

Seeing the impact of growing concerns for the obesity epidemic on the healthcare system, the AACE has provided a moredetailed, step-by-step approach to the management of obesity. Rather than looking at body mass index (BMI) alone to assess the severity of obesity, the AACE algorithm recommends a complications-centric approach to the care of overweight (BMI >27 kg/m2 but <30 kg/m2) or obese (BMI >30 kg/m2) patients.1 This complications-centric model of obesity management focuses on obesityrelated comorbidities, and these comorbidities are classified into the two categories: cardiometabolic disease and biomechanical complication.

First, the AACE obesity algorithm recommends the evaluation and staging of patients for these categories and their severity (Table l).1 The identification of metabolic syndrome and prediabetes should also be part of the evaluation because these conditions predispose individuals to high risk of future type 2 diabetes. On the other hand, it is important to note that up to 30% of obese patients may never fully develop overt diabetes or cardiovascular disease (CVD) and that they have preserved insulin sensitivity allowing them to earn the term "healthy obese."3 This, in turn, reiterates the importance of complications-centric management, rather than BMI lowering, in overweight or obese patients as cardiometabolic disease complications are independent of baseline BMI in many cases.1

In November 2013, the American Heart Association (AHA)/American College of Cardiology (ACC) Task Force on Practice Guidelines and The Obesity Society (TOS) have published the guideline for the Management of Overweight and Obesity in Adults.4 The 2013 AHA/ACC/TOS obesity guideline still uses BMI and waist circumference as the main methods for identifying overweight and obese patients (overweight is defined as BMI >25.0-29.9 kg/m2 in the obesity gjideline). The AHA/ACC/TOS obesity guideline also recognizes the risks of CVD, type 2 diabetes, and all-cause mortality associated with obesity. It recommends assessment of CVD risk factors and counseling the patients on the benefits of lifestyle changes on CVD risk factors.4

Once overweight or obese patients are appropriately evaluated for their complications, therapeutic interventions can take place. Lifestyle modification is recommended for all overweight and obese patients, and pharmacological and surgical interventions can be considered for patients with comorbidities. …

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