of Diabetes" now includes the use of the A1c level for diabetes
diagnosis, with a cutoff point of 6.5%.
"Diagnosis of Pre-diabetes" is now named "Categories of Increased Risk for Diabetes." Categories suggesting an increased risk for future diabetes now include an A1c range of 5.7% to 6.4%, as well as impaired fasting glucose and impaired glucose tolerance levels.
believe that use of the A1c, because it doesn't require fasting, will
encourage more people to get tested for type 2 diabetes and help further
reduce the number of people who are undiagnosed but living with this chronic
and potentially life-threatening disease," Richard M. Bergenstal, MD,
ADA president-elect of medicine & science, said in a news release.
"Additionally, early detection can make an enormous difference in a
person's quality of life. Unlike many chronic diseases, type 2 diabetes
actually can be prevented, as long as lifestyle changes are made while blood
glucose levels are still in the pre-diabetes range."
HbA1c(A1c) test, which measures average blood glucose levels for a
period of up to 3 months, was previously used only to evaluate diabetic
control with time. An A1c level of approximately 5% indicates the absence of
diabetes, and according to the revised evidence-based guidelines, an A1c
score of 5.7% to 6.4% indicates prediabetes, and an A1c level of 6.5% or
higher indicates the presence of diabetes.
optimal diabetic control, the recommended
fasting plasma glucose testing and the oral glucose tolerance test, A1c
testing does not require overnight fasting. Compliance with screening may
therefore be improved through use of the A1c test, which can be determined
from a single nonfasting blood sample.
Changes for 2010
changes in the 2010 Clinical Practice Recommendations are as follows:
A section on diabetes related to cystic fibrosis has been added to "Standards of Medical Care in Diabetes." New evidence has shown that early diagnosis of cystic fibrosis-related diabetes and aggressive treatment with insulin have narrowed the gap in mortality between patients with cystic fibrosis with and without diabetes and have eliminated the sex difference in mortality rates. New recommendations for the clinical management of cystic fibrosis-related diabetes, based on a 2009 consensus conference, will be published in 2010 in a consensus report.
of the section "Diagnosis of Diabetes" now includes the
use of the A1c level for diabetes diagnosis, with a cutoff point of 6.5%.
The section formerly named "Diagnosis of Pre-diabetes" is now named "Categories of Increased Risk for Diabetes." Categories suggesting an increased risk for future diabetes now include an A1c range of 5.7% to 6.4%, as well as impaired fasting glucose and impaired glucose tolerance levels.
to the section "Detection and Diagnosis of GDM [Gestational
Diabetes Mellitus]" now include a discussion of possible future
changes in this diagnosis, according to international consensus.
Screening recommendations for gestational diabetes are to use risk
factor analysis and an oral glucose tolerance test, if appropriate.
Women diagnosed with gestational diabetes should be screened for
diabetes 6 to 12 weeks postpartum and should have subsequent screening
for the development of diabetes or prediabetes.
revisions to the section "Diabetes Self-Management
Education" are based on new evidence. Goals of diabetes
self-management education are to improve adherence to standard of care,
to educate patients regarding appropriate glycemic targets, and to
increase the percentage of patients achieving target A1c levels.
revisions to the section "Antiplatelet Agents" now
reflect evidence from recent trials suggesting that in moderate- or
low-risk patients, aspirin is of questionable benefit for primary
prevention of cardiovascular disease. The revised recommendation is to
consider aspirin treatment as a primary prevention strategy in patients
with diabetes who are at increased cardiovascular risk, defined as a
10-year risk greater than 10%. Patients at increased cardiovascular risk
include men older than 50 years or women older than 60 years with at
least 1 additional major risk factor.
photography may be used as a screening strategy for retinopathy, as
described in the section "Retinopathy Screening and
Treatment." However, although high-quality fundus photographs
detect most clinically significant diabetic retinopathy, they should not
act as a substitute for an initial and dilated comprehensive eye
examination. Retinal examinations should be carried out annually or at
least every 2 to 3 years among low-risk patients with normal eye
examination results in the past.
revisions to the section "Diabetes Care in the Hospital" now
question the benefit of very tight glycemic control goals in critically
ill patients, based on new evidence.
revisions to the section "Strategies for Improving Diabetes
Care" are based on newer evidence. Successful strategies to
improve diabetes care, which have resulted in improved process measures
such as measurement of A1c levels, lipid levels, and blood pressure,
include the following:
most successful practices have an institutional priority for quality of
care, involve all of the staff in their initiatives, redesign their delivery
system, activate and educate their patients, and use electronic health
record tools," the guidelines authors conclude. "It is clear that
optimal diabetes management requires an organized, systematic approach and
involvement of a coordinated team of dedicated health care professionals
working in an environment where quality care is a priority."
Diabetes Care. December 29, 2009; January 2010 Supplement.
Toprani Advanced Lab Systems, 2010
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