Standards of Medical Care in Diabetes: 2018

Criteria guiding the medical community for screening patients for diabetes can vary based on the professional group making the recommendations.  For example, the screening guidelines by the United States Preventive Service Task Force (2015) is less stringent that the screening guidelines by the American Diabetes Association (2018).

The 2015 screening guidelines from the United States Preventive Service Task Force (USPSTF) recommend patients be screened for diabetes if they are between 40 and 70 years old and are overweight or obese. But a recent study published in Public Library of Science (PLOS)  found many patients outside those age and weight ranges develop diabetes, especially racial and ethnic minorities.  This study suggests that the USPSTF widely accepted screening guidelines miss identifying many patients with diabetes and prediabetes.

The American Diabetes Association (ADA) recommends testing all adults beginning at age 45 years, regardless of weight, and all adults without symptoms of diabetes at any age if they are overweight or obese and have one or more additional risk factors for diabetes.  This screening recommendation was revised by the ADA for the purpose of clarifying the relationship between age, BMI, and risk for type 2 diabetes and prediabetes.

1. Testing should be considered in all adults who are overweight (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and have additional risk factors:

  • Physical inactivity

  • First-degree relative with diabetes

  • High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander)

  • Women who delivered a baby weighing >9 lb or were diagnosed with GDM

  • Hypertension (≥140/90 mmHg or on therapy for hypertension)

  • HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)

  • Women with polycystic ovary syndrome

  • A1C ≥5.7% (39 mmol/mol), IGT, or IFG on previous testing

  • Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)

  • History of CVD

2. For all patients, testing should begin at age 45 years.
3. If results are normal, testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results (e.g., those with prediabetes should be tested yearly) and risk status.
References:
American Diabetes Association. (2018). Standards of Medical Care in Diabetes-2018 Abridged for Primary Care Providers. Clinical diabetes: a publication of the American Diabetes Association, 34(1), 3.
O’Brien, M. J., Lee, J. Y., Carnethon, M. R., Ackermann, R. T., Vargas, M. C., Hamilton, A., … & Buchanan, D. R. (2016). Detecting Dysglycemia Using the 2015 United States Preventive Services Task Force Screening Criteria: A Cohort Analysis of Community Health Center Patients. PLoS Med, 13(7), e1002074.  Retrieved from http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002074

 

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Hemoglobin A1c: What does it mean for diabetes self-management?

If you have been diagnosed with diabetes, you should have an A1C test every 3-6 months to determine what your average blood glucose (blood sugar) has been during the previous 3 months.  The A1C level is more heavily influenced by the most previous month of blood glucose.

Facts about A1C

  • The normal A1C for people without diabetes is 4-6%
  • The goal for A1C for people with diabetes is generally less than 7%
  • The A1C goal should be individualized.  An older person living alone may benefit from an A1C goal of 8-9%.
  • The lower the A1C for people with diabetes, the lower the risk of developing complications such as eye, heart, kidney disease and damage to the nerves to the feet.

For more information about A1C, read this article from the journal Clinical Diabetes.

Are you at risk for type 2 diabetes?

When I speak with a person who has just been diagnosed with diabetes I hear a very similar theme.  Some things I hear are “I don’t know what I did to make this happen,” “I must have been eating too much sugar,” “I didn’t know this would happen to me,” “My grandmother had diabetes and lost her legs.  I am scared this will happen to me.”

Type 2 diabetes is rarely a sudden onset.  Most people have been at risk for or had type 2 diabetes for months to years and were unaware.  If you would like to find out your risk for type 2 diabetes, take the “are you at risk” test at the American Diabetes Association website.

According to the Centers for Disease Control (CDC) nearly 90 percent of people with prediabetes are not aware they have it.  If current trends continue it is suggested that 15 to 30 percent of people with prediabetes will develop type 2 diabetes within five years (CDC, 2016).

Okay, that is the bad news.  So what is the good news?  The good news is that research shows prediabetes often can be reversed through lifestyle changes.  Prediabetes does not have to progress to diabetes.  Being aware of whether or not you have prediabetes would be important in order to monitor your health for progression to type 2 diabetes.

Ask your doctor for testing to determine if you have prediabetes if you find you are at risk for type 2 diabetes using the “are you at risk” test (ADA, 2016).  If your hemoglobin A1c (3 month blood sugar average test) is 5.7%-6.4%, you have prediabetes.

If you have prediabetes you can put measures in place to lower your risk for type 2 diabetes by 58% by losing 7% of your body weight (that would be 15 pounds if you weigh 200 pounds) and/or exercising moderately (such as brisk walking) 30 minutes a day, five days a week.  Set an achievable goal for weight loss and/or exercise and reset your goal after rewarding yourself for achieving your first goal!

Technology in Diabetes Care

The world of diabetes management is constantly changing. Technology continues to improve by leaps and bounds. While the world waits for the true artificial pancreas, learn more about how to use current technology for diabetes self-management.

Continuous Glucose Monitoring (CGM)

Recently two CGM systems—Dexcom’s G5 Mobile and Abbott’s FreeStyle Libre—are covered as durable medical equipment under Medicare Part B for beneficiaries with type 1 or type 2 diabetes who take multiple daily insulin doses and who make frequent adjustments to those doses.

Links to articles on insulin pump therapy and CGM:

Long-Term Insulin Pump Therapy Decreases Mortality in Type 1 Diabetes

Continuous Glucose Monitors: In Real Time

Insulin Pumps: Closer to a Pancreas

Walking at home: Exercise at your own pace

Who said exercise had to be planned around your daily busy life? A strategy for incorporating exercise into your morning routine is using Leslie Sansone’s Walk at Home videos. The Walk at Home youtube videos are available to view at no charge.
The first Walk at Home video I experienced was ‘Walking Down Your Blood Sugar’ DVD provided as part of a grant to patients with diabetes.

Here are a few Walk at Home videos to start with:
START! Walking at Home American Heart Association 3 Mile Walk:

1 Mile Happy Walk:

Remember to always check with your doctor before starting any exercise program.

What works in diabetes health care? Check out PubMed Health for evidence based information.

What is Clinical Effectiveness?

About Clinical Effectiveness Research

Clinical effectiveness research finds answers to the question “What works?” in medical and health care.

“Working” is a real health benefit – like symptom relief, quicker recovery, or longer life. To find out if something really works, all important effects need to be studied. That means possible harms as well as possible benefits.

Clinical or health effects are sometimes called patient-relevant outcomes.

How do researchers get from an idea to proof of clinical effectiveness?

Ideas about what could work might come from laboratory tests. There might be animal testing. Studies observing patients also generate important knowledge and theories.

But all these types of research cannot provide definite proof that a particular treatment works. Many other factors could be having an impact at the same time as treatment. People often improve with or without treatment, too.

Putting ideas, theories, and beliefs to the test

Testing clinical effectiveness in people requires experiments that can single out the true effects of specific actions. That is why the possible effects of treatments and prevention methods need to be studied in clinical trials.

One trial is rarely enough to provide definite answers. Later trials sometimes confirm early results – and sometimes come up with conflicting results. So researchers search for, and then analyze, all the trials that have studied particular questions. This type of research is called a systematic review. It can be used to look for studies other than trials as well, and address other questions – like, “What causes this disease?”

Definite answers and areas of uncertainty

Systematic reviews can show which treatments and prevention methods have been proven to work – and what remains unknown. Being clear about what is certain or uncertain is an important part of informed decision-making.

Systematic reviews are the basis for what is often called evidence-based medicine or health care. And they are important for pointing to areas where more research is needed.

Other names for this kind of research are “evidence syntheses”, “comparative effectiveness reviews”, and “health technology assessments”.
By PubMed Health, reviewed 27 October 2015

 

Hello world: About me

Warlick_Kim_30 YEAR PIC WAKEMED edit2

Hello to all my friends, colleagues, and to those who are just browsing and stumble upon my site.

With the creation of my professional website,  I feel welcomed into the world of social media.

A little bit about me:

I have an inquisitive soul.  I love that I can travel anywhere on my laptop or phone from wherever I happen to be at that very moment.  Growing up on a small tobacco farm in rural Johnston County in North Carolina, my world was open, airy, very close to nature.  I loved walking in the freshly turned soil in the springtime as my father prepared the fields for a new crop or a new garden.  I could freely roam the woods and enjoy the nature that I felt was my oneness with my higher power.  A connection was palpable for me with that oneness.  Once, in my youth, I found a spirit-filled place in the woods at a large vibrant-with-life tree.  I posted a sign announcing that this spot was “Paradise: Population 1”.  I constantly seek now for that same spirit-filled place in my adult life.

When I was a small child I had several experiences as a patient in the hospital.  I fell in love with my nurses.  At the age of four, I knew somewhere inside my soul was a budding nurse.  I nursed runt pigs, small puppies, and any vulnerable living thing I encountered.  I have been a nurse now for over 33 years.  I have had the privilege of being a nurse for my father who taught me so much about loving nature and is now in the most glorious nature of all, Paradise.  I pursued higher education in my 50s and am still in awe that I now have a masters degree in nursing and have found a higher calling than caring for people I encounter in the hospital or clinic.  I am an Adult Clinical Nurse Specialist and Certified Diabetes Educator.  I feel called to connect with anyone who finds that my website may help them either learn more about themselves or more about how to care for the ones they love.

Welcome to my world!

kim