New clinical practice guidelines from the American Association of Clinical Endocrinologists address the development of a diabetes comprehensive care plan.
Published April 5, the new clinical practice guideline (CPG) is intended to complement and extend existing guidelines available in the literature, including previous CPGs from AACE. The new document advocates a comprehensive approach to routine diabetes management, based on evidence that, although glycemia control variables such as hemoglobin A1c and glucose excursions have an impact on cardiovascular disease risk, other factors – including obesity, blood pressure, dyslipidemia, and hypercoagulation – also play important roles (Endocr. Pract. 2011;17 [suppl2]).
"Our goals for these guidelines are to provide the health care professional with tools to develop a comprehensive care plan for the prevention and management of diabetes and its complications, addressing not just hyperglycemia, but all associated cardiovascular risk factors," writing committee cochair and AACE president-elect Yehuda Handelsman said in an interview.
The document advocates an individualized approach to treatment, with personalized goals based on duration of diabetes, comorbidities, longevity, and the ability to provide treatment safely. In addition to type 2 diabetes, the CPG also addresses the care of individuals with prediabetes, type 1 diabetes, children/adolescents and pregnant women with diabetes, and hospitalized patients with hyperglycemia.
Controversies in diabetes care, such as new diagnostic criteria of diabetes, medication, and surgical treatment are also included, as are new technologies such as insulin pumps and continuous glucose monitoring. Less familiar areas such as sleep and breathing disturbances and depression are also addressed.
The document is divided into an executive summary containing the recommendations in a question-and-answer format, and an appendix providing the respective supporting evidence for each recommendation.
According to Dr. Handelsman, medical director and principal investigator of the Metabolic Institute of America, Tarzana, Calif., "These state-of-the-art guidelines provide the most up to date evidence-based answers to real-life questions to enable the health care provider to deliver the most relevant, individualized treatment plan for patients with diabetes."
Dr. Handelsman reported that he has received speakers bureau honoraria from AstraZeneca, Bristol-Myers Squibb/AstraZeneca, Daiichi Sankyo, GlaxoSmithKline, Merck & Co., and Novartis AG; consultant honoraria from BMS/AstraZeneca, Daiichi Sankyo, Gilead, Genentech, GSK, Merck, XOMA, Tethys Bioscience, and Tolerx; and research grant support from Daiichi Sankyo, GSK, Novartis, Novo Nordisk A/S, Takeda Pharmaceuticals, Sanofi-Aventis U.S., XOMA, and Tolerx. The CPG coauthors reported similar relationships.