Clinical Updates on Diabetes Care

By Lee, Jiehyun | Drug Topics, January 2014 | Go to article overview

Clinical Updates on Diabetes Care


Lee, Jiehyun, Drug Topics


Abstract

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. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Clinical Updates on Diabetes Care
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.