RESUMO
This article is adapted from the virtual address Ms. Hess-Fischl delivered as the recipient of the American Diabetes Association's Outstanding Educator in Diabetes Award for 2022. She delivered the address in June 2022 during the Association's 82nd Scientific Sessions in New Orleans, LA. A webcast of this speech is available for viewing on the DiabetesPro website (https://professional.diabetes.org/webcast/president-health-care-education-address-and-outstanding-educator-diabetes-award-lecture).
RESUMO
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycaemia, behavioural considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that healthcare professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors. Graphical abstract.
Assuntos
Diabetes Mellitus Tipo 1 , Adulto , Glicemia , Automonitorização da Glicemia , Consenso , Diabetes Mellitus Tipo 1/terapia , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêuticoAssuntos
American Medical Association/organização & administração , Consenso , Diabetes Mellitus Tipo 2/reabilitação , Diabetes Mellitus Tipo 2/terapia , Dietética/organização & administração , Profissionais de Enfermagem/organização & administração , Nutricionistas/organização & administração , Educação de Pacientes como Assunto/organização & administração , Farmacêuticos/organização & administração , Assistentes Médicos/organização & administração , Médicos de Família/organização & administração , Sistemas de Apoio Psicossocial , Autogestão/educação , Sociedades Médicas/organização & administração , Sociedades Farmacêuticas/organização & administração , Adulto , Feminino , Humanos , Masculino , Estados UnidosRESUMO
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.
Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Adulto , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Humanos , InsulinaRESUMO
Fasting the Holy month of Ramadan constitutes one of the five pillars of the Muslim faith. Although there is some evidence that intermittent fasting during Ramadan may be of benefit in losing weight and cardiometabolic risk factors, there is no strong evidence these benefits apply to people with diabetes. The American Diabetes Association/European Association for the Study of Diabetes consensus recommendations emphasize the importance of patient factors and comorbidities when choosing diabetes medications including the presence of comorbidities, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, hypoglycemia risk, weight issues and costs. Structured education and pre-Ramadan counseing are key components to successful management of patients with diabetes. These should cover important aspects like glycemic targets, self-monitoring of blood glucose, diet, physical activity including Taraweeh prayers, medication and dose adjustment, side effects and when to break the fast. The decision cycle adapted for the specific situation of Ramadan provides an aid for such an assessment. Children with type 1 diabetes should strongly be advised not to fast due to the high risk of acute complications such as hypoglycemia and probably diabetic ketoacidosis (DKA), although there is very little evidence that DKA is increased in Ramadan. Pregnant women with diabetes or gestational diabetes should be advised to avoid fasting because of possible negative maternal and fetal outcomes. Hypoglycemia is a common concern during Ramadan fasting. To prevent hypoglycemic and hyperglycemic events, we recommend the adoption of diabetes self-management education and support principles. The use of the emerging technology and continuous glucose monitoring during Ramadan could help to recognize hypoglycemic and hyperglycemic complications related to omission and/or medication adjustment during fasting; however, the cost represents a significant barrier.
Assuntos
Diabetes Mellitus , Hipoglicemia , Glicemia , Automonitorização da Glicemia , Criança , Consenso , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Jejum , Feminino , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/prevenção & controle , GravidezAssuntos
Consenso , Diabetes Mellitus Tipo 2/terapia , Educação de Pacientes como Assunto/métodos , Autogestão/educação , Autogestão/métodos , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/terapia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/economia , Dietética , Humanos , Profissionais de Enfermagem , Terapia Nutricional , Equipe de Assistência ao Paciente , Farmacêuticos , Assistentes Médicos , Atenção Primária à Saúde/métodos , Estados UnidosRESUMO
The purpose of this article was to provide an overview of the management of the hospitalized patient with diabetes. Having a basic knowledge of their needs is essential to maintain blood glucose control and reduce the risk of long-term complications. It is also essential to reduce the risk of hypoglycemic reactions due to reduced carbohydrate intake with subsequent diabetes medication administration. The most frequent reason for hypoglycemia is insulin administration along with a reduction in the amount of carbohydrate consumed. Practical advice is included to aid the medical staff to help maintain consistency in the amount of carbohydrate in meals as well as increase the knowledge base of carbohydrate content of common foods.