NEW ADA type 2 diabetic guidelines

[RobLL]

Step 1 is lifestyle intervention and use of metformin because of its effect on glycemia, absence of weight gain or hypoglycemia, good tolerability profile, and relatively low cost. Lifestyle changes should aim to improve glucose levels, blood pressure, and lipid levels, and to promote weight loss or at least to avoid weight gain. As tolerated, metformin should be titrated to its maximally effective dose at 1 to 2 months.

Step 2 is to add another medication, either insulin or a sulfonylurea, within 2 to 3 months of starting step 1 or at any time when target hemoglobin A1c level is not achieved or if metformin is contraindicated or poorly tolerated. For patients who have hemoglobin A1c level of more than 8.5% or symptoms secondary to hyperglycemia, insulin is preferred, typically a basal (intermediate- or long-acting) insulin.

Step 3 involves further adjustments by starting or intensifying insulin therapy with additional injections that might include a short- or rapid-acting insulin given before selected meals to curtail postprandial hyperglycemia. Insulin secretagogues (sulfonylurea or glinides) should be discontinued, or tapered and then discontinued, once insulin injections are started.
The tier 2 algorithm consists of less well-validated therapies that may be considered in selected clinical settings, such as in patients with hazardous jobs that would make hypoglycemia particularly dangerous. In these patients, adding exenatide or pioglitazone may be considered, although rosiglitazone is not recommended.

From this mornings Diabetes in Control Web Site

who wudda thought!

[eddiemcm]

Maybe the concept of "lifestyle intervention" should be defined
a bit(maybe even including locarb diet).
Maybe a trailer comment should be:
"These statements have not been evaluated by the FDA".
Darn!I forgot the ADA is an FDA pet.
<chuckle>
Eddie

[Cajunboy47]

I've been following part of their new advice, does that mean they can take credit for my successes?

I have had a "Lifestyle Intervention"......... but, that is my departure from their recommendations.

I don't know if Rob is offering a summary or the whole "new" guidelines, but if you read it closely, it gives the impression it takes months to get you A1C down and they warn of "hypos" which of course is what there methods produce; a gradual increase in medications and a life of worrying about "hypos".....

In my opinion, they still don't get it!!!!

[RobLL]

Not at all a perfect statement. We all realize how political it likely was to make the changes noted above. In my own case I read three things that would have encouraged a doctor to Rx insulin:

First off: symptom secondary to hyperglycemia - Retinopathy

Second: Metformin is counterindicated or poorly tolerated

Third: Target A1C level not reached, here of course is the fight, my goal is A1Cs of less than 5.

But as a matter of my general approach to life, when an organization which I have not admired makes BIG steps in the direction of truth, I am willing to give them credit. Can you imagine the pain and discussion that went into generally recommending against ALL of the newer diabetic drugs. That must have been a HUGE fight.

But we have not seen the full report, that could change everything - in either direction.

[RCo]

It looks to me like they are still trying to push drugs as a high priority, but I am pleased that they appear to no longer regard the use of insulin as the exclusive domain of Type 1's.

They do still appear to be ignoring the low carb diet as a long term option (although I read last year that they now acknowledged it as a weight loss option). I am waiting for someone in the US mainstream to admit they need not have written Bernstein off as nuts too.

I am interested in what happens over there, because Diabetes UK are quite likely to follow what the ADA do. It may take a year or two, but usually it goes that way.

[Cajunboy47]

Rob,

You do make a valid point, that there was a change and for the ADA, that is a big step. I remember how much trouble you had trying to get your Doctor to prescribe insulin and can imagine how for many diabetics, they are also having trouble getting the proper prescription for their needs....

I do strongly believe we should all be able to have access to whatever methods we choose to control our diabetes. I think that once any diabetic has a fairly good understanding of diabetes and makes full use of monitoring and has the right motivation to care for him/herself, I think the medical establishment should support that individual.

I'm too lazy to start another thread, but I'd like to throw this out there, since we're talking ADA....

I know that statistics are manipulated for commercial gain and I'm sure it is done more often then we even imagine. I wonder if the increase in people with diabetes isn't because diabetics are now controlling their diabetes better and are living longer and if the numbers are not somewhat inflated due to that... hmmmmmmmmm.....

Happy Halloween
Ron

[RCo]

I know that a few decades ago the medical profession were sincerely hoping to diagnose more Type 2 Diabetics earlier in the progress of the disease, because they were so frequently finding people and diagnosing them after it had blinded them or destroyed a foot. I saw posters and adverts funded by the National Health Service and Diabetes UK (both officially not for profit), explaining early symptoms and offering random tests for people whose relatives had it. I don't know what happened in the USA, but I would have thought the general policy of the health organizations would have been similar. It might not explain everything about the increasing statistics, but even if it only explains part of them, IMHO more T2 diabetics knowing that they are in time to prevent losing feet and eyesight is a good thing. It means increased numbers in terms of diagnosis rates, and lower numbers in terms of age at time of diagnosis, but this in fact means more diabetes is under control, more feet are staying on, not necessarily more of the disease itself is happening.

Statistics can easily be used to scare people, and after that has worked all logic collapses. Look at it this way...being alive carries a 100 per cent chance of ending in death. We can prevent death here...ban life.