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AACE releases new guidelines for diabetes management
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American Association of Clinical Endocrinologists 20th Annual Meeting
SAN DIEGO — As the incidence of diabetes continues to grow worldwide, addressing prevention and treatment has become a primary concern for endocrinologists. Consequently, the American Association of Clinical Endocrinologists recently issued new guidelines for developing a comprehensive care plan to manage diabetes.
“This guidance is for individual clinicians, for insurers, for government policy and for patients so these guidelines reverberate among the 150 million people who are involved in the world of diabetes,” Daniel Einhorn, MD, 2010-2011 president of AACE, said during a press conference.
Noteworthy updates
A group of 23 experts in a variety of fields collaborated to produce the guidelines, according to Yehuda Handelsman, MD, co-chair of the guidelines writing committee and AACE president-elect. Their goal was to gain perspective from all areas to create personalized goals and individualize therapy.
“This comprehensive approach is based on the evidence that although glycemic control parameters (HbA1c, postprandial glucose excursions, fasting plasma glucose, glycemic variability) have an impact on cardiovascular disease risk, mortality, and quality of life, other factors also affect clinical outcomes in persons with diabetes,” the committee wrote.
One updated recommendation addresses the diagnostic criteria for gestational diabetes. Previously, pregnant women were administered a 50-g, 1-hr oral glucose tolerance test. Now, the guidelines recommend physicians use a 75-g, 2-hour OGTT to diagnose gestational diabetes.
The guidelines also now endorse a target HbA1c level lower than 6.5%, as most nonpregnant healthy adults can safely reach this goal. Physicians should, however, consider each patient’s unique situation. Aggressive treatment, for instance, would be more appropriate in a young, healthy patient than in an elderly patient or a patient with a terminal illness, Handelsman noted.
The experts also provide information and recommendations for using new technologies, including insulin pump therapy and continuous glucose monitoring, as well as less familiar topics such as sleep and breathing disturbances and depression.
Importance of individualized therapy
Diabetes prevention also received attention in the guidelines. Carefully monitoring patients with prediabetes by regularly assessing their fasting plasma glucose levels or administering OGTTs is recommended, according to Handelsman. In addition, treating obesity is essential.
“We believe that addressing, treating and managing obesity is key to preventing and controlling diabetes and comorbidities,” Handelsman said. Therefore, the guidelines discuss lifestyle modifications, nutritional management, physical activity as well as the potential benefits of surgical options, such as gastric bypass, in appropriate patient populations.
Handelsman stressed the importance of not simply aiming to control diabetes. Lipid profiles, blood pressure and cardiovascular disease risk should be taken into account, and physicians should consider all of these aspects when generating a comprehensive diabetes care plan.
“Dr. Handelsman and the team of writers understood the need to be truly comprehensive in every aspect. Every single thing about the person with diabetes matters to the outcomes,” Einhorn said. “This is the first year that the guidelines are so comprehensive, and they will continue to grow and be expanded from here.” - by Melissa Foster
For more information:
- Handelsman Y. Endocr Pract. 2011;17:287-301.
- Handelsman Y. Workshops – Session 1. AACE diabetes mellitus clinical practice guidelines. Presented at: American Association of Clinical Endocrinologists 20th Annual Meeting; April 13-17, 2011; San Diego.