RESUMO
DESCRIPTION: The American Diabetes Association (ADA) updates the Standards of Medical Care in Diabetes annually to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of diabetes. METHODS: To develop the 2020 Standards, the ADA Professional Practice Committee, comprising physicians, adult and pediatric endocrinologists, diabetes educators, registered dietitians, epidemiologists, pharmacists, and public health experts, continuously searched MEDLINE (English language only) from 15 October 2018 through August-September 2019 for pertinent studies, including high-quality trials that addressed pharmacologic management of type 2 diabetes. The committee selected and reviewed the studies, developed the recommendations, and solicited feedback from the larger clinical community. RECOMMENDATIONS: This synopsis focuses on guidance relating to the pharmacologic treatment of adults with type 2 diabetes. Recommendations address oral and noninsulin injectable therapies, insulin treatment, and combination injectable therapies. Results of recent large trials with cardiovascular and renal outcomes are emphasized.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Glicemia/análise , Diabetes Mellitus Tipo 2/sangue , Quimioterapia Combinada , Receptor do Peptídeo Semelhante ao Glucagon 1/antagonistas & inibidores , Hemoglobinas Glicadas/análise , Humanos , Insulina/uso terapêuticoRESUMO
The proliferation of smartphones over the past decade has led to the development of a seemingly endless number of digital applications (apps) designed to improve users' health and fitness. This article addresses the regulation of these apps and provides details about the apps most commonly used by patients in the primary care and diabetes settings. Those described in detail include the American Diabetes Association's Standards of Care app, apps for blood glucose monitoring and tracking and continuous glucose monitoring, lifestyle apps, a glucagon use app, prescription cost-saving apps, and apps for do-it-yourself automated insulin delivery.
RESUMO
Description: The American Diabetes Association (ADA) annually updates its Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. Methods: The ADA Professional Practice Committee comprises physicians, adult and pediatric endocrinologists, diabetes educators, registered dietitians, epidemiologists, pharmacists, and public health experts. To develop the 2019 standards, the committee continuously searched MEDLINE through November 2018 to consider and review studies, particularly high-quality trials including persons with diabetes, for potential incorporation into recommendations. It also solicited feedback from the larger clinical community. Recommendations: This synopsis focuses on selected guidance relating to use of diabetes technology in adults with diabetes. Recommendations address self-monitoring of blood glucose, continuous glucose monitors, and automated insulin delivery systems.
Assuntos
Automonitorização da Glicemia , Glicemia/análise , Diabetes Mellitus/terapia , Hipoglicemiantes/administração & dosagem , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Complicações do Diabetes/prevenção & controle , Gerenciamento Clínico , Humanos , Estados UnidosRESUMO
Description: The American Diabetes Association (ADA) annually updates its Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. Methods: For the 2018 standards, the ADA Professional Practice Committee searched MEDLINE through November 2017 to add, clarify, or revise recommendations on the basis of new evidence. The committee rated the recommendations as A, B, or C depending on the quality of evidence or E for expert consensus or clinical experience. The standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions. Recommendations: This synopsis focuses on guidance relating to cardiovascular disease and risk management in nonpregnant adults with diabetes. Recommendations address diagnosis and treatment of cardiovascular risk factors (hypertension and dyslipidemia), aspirin use, screening for and treatment of coronary heart disease, and lifestyle interventions.
Assuntos
Doença das Coronárias/prevenção & controle , Diabetes Mellitus/terapia , Angiopatias Diabéticas/prevenção & controle , Dislipidemias/prevenção & controle , Hipertensão/prevenção & controle , Padrão de Cuidado , Adulto , Anti-Hipertensivos/uso terapêutico , Aspirina/uso terapêutico , Monitorização Ambulatorial da Pressão Arterial , Doença das Coronárias/diagnóstico , Diabetes Mellitus/tratamento farmacológico , Dislipidemias/diagnóstico , Estilo de Vida Saudável , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/diagnóstico , Hipoglicemiantes/uso terapêutico , Inibidores da Agregação Plaquetária/uso terapêutico , Fatores de Risco , Gestão de RiscosRESUMO
DESCRIPTION: The American Diabetes Association (ADA) annually updates Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. METHODS: For the 2017 Standards of Care, the ADA Professional Practice Committee did MEDLINE searches from 1 January 2016 to November 2016 to add, clarify, or revise recommendations on the basis of new evidence. The committee rated the recommendations as A, B, or C, depending on the quality of evidence, or E for expert consensus or clinical experience. The Standards of Care were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions. RECOMMENDATION: This synopsis focuses on recommendations from the 2017 Standards of Care about monitoring and pharmacologic approaches to glycemic management for type 1 diabetes.
Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Glicemia/análise , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/sangue , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemia/induzido quimicamente , Hipoglicemia/classificação , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/farmacocinética , Insulina/efeitos adversos , Insulina/farmacocinética , Insulina/uso terapêutico , Polipeptídeo Amiloide das Ilhotas Pancreáticas/uso terapêutico , Liraglutida/uso terapêutico , Metformina/uso terapêuticoRESUMO
DESCRIPTION: The American Diabetes Association (ADA) annually updates the Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes. METHODS: For the 2017 Standards, the ADA Professional Practice Committee updated previous MEDLINE searches performed from 1 January 2016 to November 2016 to add, clarify, or revise recommendations based on new evidence. The committee rates the recommendations as A, B, or C, depending on the quality of evidence, or E for expert consensus or clinical experience. The Standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions. RECOMMENDATIONS: This synopsis focuses on recommendations from the 2017 Standards about pharmacologic approaches to glycemic treatment of type 2 diabetes.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Diabetes Mellitus Tipo 2/sangue , Custos de Medicamentos , Quimioterapia Combinada , Medicina Baseada em Evidências , Hemoglobinas Glicadas/análise , Humanos , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/economia , Insulina/efeitos adversos , Insulina/economia , Insulina/uso terapêutico , Metformina/efeitos adversos , Metformina/uso terapêuticoRESUMO
DESCRIPTION: The American Diabetes Association (ADA) published the 2016 Standards of Medical Care in Diabetes (Standards) to provide clinicians, patients, researchers, payers, and other interested parties with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. METHODS: The ADA Professional Practice Committee performed a systematic search on MEDLINE to revise or clarify recommendations based on new evidence. The committee assigns the recommendations a rating of A, B, or C, depending on the quality of evidence. The E rating for expert opinion is assigned to recommendations based on expert consensus or clinical experience. The Standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community was incorporated into the 2016 revision. RECOMMENDATIONS: The synopsis focuses on 8 key areas that are important to primary care providers. The recommendations highlight individualized care to manage the disease, prevent or delay complications, and improve outcomes.
Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Adulto , Automonitorização da Glicemia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/terapia , Angiopatias Diabéticas/prevenção & controle , Nefropatias Diabéticas/prevenção & controle , Neuropatias Diabéticas/prevenção & controle , Hemoglobinas Glicadas/metabolismo , Hospitalização , Humanos , Hiperglicemia/terapia , Hipoglicemia/terapia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Estado Pré-Diabético/diagnóstico , Fatores de RiscoRESUMO
BACKGROUND: We assessed the impact of "almost daily" use of continuous glucose monitoring (CGM) in adults with type 1 diabetes who had at least 1 year of CGM experience. METHODS: In this single-center survey, we utilized a 16-item questionnaire to assess changes hypoglycemia fear, incidence of emergency medical treatment and utilization of self-monitoring of blood glucose (SMBG) before and after 1 year of CGM use. Participation was restricted to individuals who used the same brand of CGM system to avoid confounding responses due to differences between commercial devices. Participants were recruited on an "as-seen" basis from a major, urban internal medicine clinic and associated diabetes education center. The questionnaire was completed during the clinic visit. Responses to the survey were analyzed by standard descriptive statistics. RESULTS: Seventy-four patients completed the survey: 42.9 years (range: 23-71 years), 38 (51%) female, 59 current insulin pump users. Most (84%) reported wearing their devices "almost daily" (n = 58) or 3 weeks per month (n = 4). "Almost daily" users reported an 86% reduction in incidence of emergency medical treatment events (P = .0013) and >50% reduction in daily SMBG frequency (P < .0001). Reductions in hypoglycemia fear were apparent but not statistically significant (P = .7359). CONCLUSIONS: "Almost daily" use of CGM with the Dexcom G4 system reduced incidence of emergency treatment events and daily SMBG utilization among survey respondents and a trend toward reduced hypoglycemia fear. This may indicate cost savings in reduction of emergency medical intervention and likely improved quality of life without increasing safety concerns related to hypoglycemia.
Assuntos
Automonitorização da Glicemia/estatística & dados numéricos , Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Sistemas de Infusão de Insulina/psicologia , Adulto , Idoso , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
We assessed the impact of perceived insulin pump usability on attitudes toward insulin pump therapy in diabetic individuals currently treated with multiple daily insulin injections (MDI). This comparative, single-arm study recruited 28 adults with type 1 (n = 16) and insulin-treated type 2 diabetes (n = 12) to evaluate 2 current insulin pumps: Medtronic Revel 723 (Pump 1), Asante Snap Insulin Pump (Pump 2). Participants were randomized 1:1 to 1 of 2 assessment sequences: Pump 1 followed by Pump 2; and Pump 2 followed by Pump 1. Structured observational protocols were utilized to assess participants' ability and time required to learn/perform common tasks associated with pump setup/use. Participants used a modified version of the System Usability Scale (SUS) and investigator-developed questionnaires to rate pump usability and task difficulty; pre-post questionnaires assessed changes in attitudes toward insulin pump therapy. All participants completed the study. SUS scores showed Pump 2 to be more usable than Pump 1 on all usability attributes. Participants rated Pump 2 more positively than Pump 1, overall mean SUS scores of 5.7 versus 4.1 respectively, F(1, 52) = 32.7, P < .001, and SUS scores were higher if participants used the Pump 2 last, 5.3 versus 4.4 for Pump 1 last, F(1, 52) = 10.8, P < .01. Pump 2 was preferred for all tasks: manual bolus (86%), bolus calculation (71%), managing basal rates (93%), interpreting alarms (96%), transferring settings (100%), changing insulin and infusion sets (93%), all P < .05. Perceptions of pump usability can directly impact acceptance and use of features that may benefit those who wear them. Simpler pump devices that decrease perceptions of complexity may encourage broader use of this technology.