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116), Scottish Intercollegiate Guideline Network. Diagnosis of Diabetes Referral to Beaumont Diabetes Service Diagnosis of Type 2 Diabetes 2 Healthy eating 3. Blood sugar monitoringThese steps will help keep your blood sugar level closer to normal, which can delay or prevent complications. Patients with diabetes requiring antihypertensive treatment should be commenced on: an angiotensin-converting enzyme [ACE] inhibitor (angiotensin receptor blockers [ARB] if ACE inhibitor intolerant), Beta blockers and alpha blockers should not normally be used in the initial management of blood pressure in patients with diabetes, Low-dose aspirin is not recommended for primary prevention of vascular disease in patients with diabetes, Lipid-lowering drug therapy with simvastatin 40 mg or atorvastatin 10 mg is recommended for primary prevention in patients with type 2 diabetes aged >40 years regardless of baseline cholesterol, Intensive insulin treatment to be continued for at least 24 hours in patients with myocardial infarction, Treat patients with an ST elevation immediately with primary percutaneous coronary intervention, When primary percutaneous coronary intervention cannot be provided within 90 minutes of diagnosis, patients with an ST elevation acute coronary syndrome should receive immediate thrombolytic therapy, Long term aspirin (75 mg per day) should be given routinely. These guidelines provide recommendations based on current evidence for best practice in the management of diabetes. 2020 Diabetes Self-management Education and Support in Adults With Type 2 Diabetes. The onset of Type 2 diabetes is subtle and early detection in general practice requires clinical suspicion combined with systematic and opportunistic case-finding, as diagnosis is frequently delayed until complications appear. Subsequent antibiotic regimens may be modified with reference to bacteriology and clinical response, Suspected Charcot neuroarthropathy of the foot is an emergency and should be referred immediately to the multidisciplinary foot team, Patients with active diabetic foot disease should be referred to a multidisciplinary diabetic foot care service, The initial treatment of diabetic peripheral neuropathy (DPN) is dependent on individual patient choice, dosing regimens, cost and side-effect profile, Consider antidepressants or anticonvulsants for treatment of painful DPN. Edinburgh: SIGN; 2017. ... 2020 Cost-effectiveness of Interventions to Manage Diabetes. What’s New in 2020 First, additional agents approved for use in Canada have been shown to have cardiovascular (CV) benefits in patients with type 2 diabetes. �Z��2������o5,׫p��V�mꗄ��+�:��E@2������W*MY'�Dj���a屙�r���f���vi�.��O^�+-�f���{3�E?�0�������X�Mņ#�X?�=�� Type 2 Diabetes Guidelines Expert Committee. None of the major diabetes guidelines currently recommend general screening for Type 2 diabetes. 1): S73-S85 Learning Objectives )�8SB���H�8&!J���IA��f�T��8�dU.�B!��QȥH��E$a�TS�cg��F%�$�^P�Q�R��$K�c�9�a�"V(�HȣP"��rJ�1�R"�Hk��5z/�-�pΗS�s+^��#*�T�z�[/ǃz�0 ������!וGEiN�����W����r�^�RF���������~�ȴv��iq�f�ӑ����p4��u37%�{BH8��4�C�`��YZ M�M+����7��d䍷06�W/�����GXΝۓƬ���{��1U�0��ƫ������y���0�Q?�4Z�S^.��l9wU�:�UDQ�CA��R�_) This succinct summary highlights the treatment recommendations for type 2 diabetes by cardiovascular/renal disease or risk factor. Read the Guidelines in Practice article Adults with type 2 diabetes should receive structured education for more information on the implementing NICE guideline 28 on Type 2 diabetes in adults: management To cite a specific chapter: The Society for Endocrinology, Metabolism and Diabetes of South Africa Type 2 Diabetes Guidelines Expert Committee. 1. Eventually your pancreas can’t keep up, and your blood sugar rises, setting the stage for prediabetes and type 2 diabetes. (SIGN Guidelines No. SMBG may be considered in the following groups of people with type 2 diabetes who are not using insulin: those undergoing significant changes in pharmacotherapy or fasting, for example, during Ramadan, those with unstable or poor glycaemic control (HbA, those who are pregnant or planning pregnancy, Offer obese adults with type 2 diabetes individualised interventions to encourage weight loss (including lifestyle, pharmacological or surgical interventions) to improve metabolic control, Advise all people who smoke to stop and offer support to help facilitate this to minimise cardiovascular and general health risks, Offer intensive management plus pharmacological therapies to people with diabetes who wish to stop smoking, Healthcare professionals should continue to monitor smoking status in all patient groups, All people should be advised to increase their level of physical activity to achieve current physical activity recommendations and be supported to maintain this level across the lifespan, Exercise and physical activity (involving aerobic and/or resistance exercise) should be performed on a regular basis, Advice about exercise and physical activity should be individually tailored and diabetes specific and should include implications for glucose management and foot care, Individualised advice on avoiding hypoglycaemia when exercising by adjustment of carbohydrate intake, reduction of insulin dose, and choice of injection site, should be given to patients taking insulin, People with existing complications of diabetes should seek medical review before embarking on exercise programmes, A gradual introduction and initial low intensity of physical activity with slow progressions in volume and intensity should be recommended for sedentary people with diabetes, People with type 2 diabetes can be given dietary choices for achieving weight loss that may also improve glycaemic control. Pharmacological management of glycaemic control in people with type 2 diabetes. Read about our cookies here.. They should be essential in everyday clinical decision making. Adults at high risk for atherosclerotic cardiovascular disease Education Recognition Program. If the decision is to screen, consider a frequency of every 3 years using either fasting plasma glucose or HbA1c. Subgroup Guidance (9) 7. Management of type 2 diabetes includes: 1. Pocketbook for management of diabetes in childhood and adolescence in under-resourced countries, 2nd edition . This site uses cookies, some may have been set already. Drug Classes (10) 8. SIGN 116: Management of diabetes. Diabetes management should take place in general practice 4/6 monthly Triage for Desmond • If HbA 1c < 8.0% / 64 mmol/mol - Routine DESMOND appointment • If HbA 1c 8.0 - 9.9% / 64 - 85 mmol/mol - DESMOND in 3/12 • If HbA c> 10% / 86 mmol/mol - DESMOND in 2-3 /52. QUALIFYING STATEMENTS . The IDF Life for a Child Programme and ISPAD decided it was appropriate to develop a shortened version of these guidelines aimed to be of practical use in emergency situations and in clinics that are developing expertise in managing diabetes in children. The assessing clinician will need to Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences, comorbidities, risks from polypharmacy, and their ability to benefit from long‑term interventions because of … We are fortunate to have Irish Guidelines for the Integrated Management of Type 2 Diabetes. Management of Hyperglycemia in T2DM 1. Second, some of these CV benefits have now been demonstrated in people with CV risk factors but without Type 2 diabetes: Goals for optimum management Encourage all people with type 2 diabetes to approach/reach these goals Diet Advise eating according to Australian dietary guidelines, with attention to quantity and type of food If concerns are held regarding cardiovascular disease (CVD) risk, advise individual dietary review … If you continue to use the site, we will assume you are happy to accept the cookies anyway. Pharmacotherapy Algorithm (8) 6. It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose Lifestyle Change Programs to Prevent Type 2 Diabetes. ESC Clinical Practice Guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on Diabetes / Pre-Diabetes and Cardiovascular Diseases. �H �ޔnܫnK+$����.�$l)�҄��ut��U�>3d��*6C��pM��, �=J���Lg����O5Qa Click here to access the corresponding chapter in ESC CardioMed - Section 19 Diabetes mellitus and metabolic syndrome Scottish Intercollegiate Guidelines Network, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB (Tel – 0131 623 4720), www.sign.ac.uk/sign-116-and-154-diabetes.html, Scottish Intercollegiate Guideline Network. The five Guidelines in the series, when combined, present a comprehensive set of evidence-based guidelines for the prevention, diagnosis and management of Type 2 Diabetes. ������zU���7�ZZ*�^G,+'eO��O�Oy���C���V^:��Y���v�E���L3�����0�7p'�N�����h9.�\�g0��0�˺¿� X�>������z��-�`�Z�l�B s��r�-5��,�w��S��ꂅm\=���e�-kY This guideline covers the care and management of type 2 diabetes in adults (aged 18 and over). ii | Management of type 2 diabetes: A handbook for general practice Clinical management goals Treatment targets for people with type 2 diabetes include the following. 3. The ADA guidelines still recommend Metformin as the first drug for patients with diabetes type 2 (DM2). Regular exercise 4. For a comprehensive list of assessments and screening intervals, refer to the section ‘Assessment of … This guideline covers the care and management of type 2 diabetes in adults (aged 18 and over). Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes. Weight loss 2. Read the Guidelines in Practice article Type 2 diabetes: what are the benefits and risks of glucose-lowering agents? Patient-centered care 2. Management of type 2 diabetes has to be tailored to the individual needs and circumstances of each patient - eg, the benefits of tight glucose control must be weighed against any potential complications such as recurrent hypoglycaemia [2, 3]. Management of Diabetes Mellitus in Primary Care (2017) The guideline describes the critical decision points in the Management of Diabetes Mellitus (DM) and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. Department of Defense . Recommendations on comprehensive care, glycaemic monitoring and targets, lifestyle and antihyperglycaemic interventions, and approaches to self-management and optimal models of care, This NHS guidance for general practice covers the key points of delivering diabetes care during the challenging times of the COVID-19 pandemic. Implementation strategies 4. 2435 0 obj <>stream Edinburgh: SIGN; 2017. VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF TYPE 2 DIABETES MELLITUS IN PRIMARY CARE . .�O�à��Dn9�s�&~�'�Z��,��E�Ἔ��L�l�u�� ~$=��&�H��3��L&"UJhDx��i,�Iӌ�s�G�L��d_��5RQ�G��3i�g4���;�;�/t(g�[))�~?Z |n��Xx�o�wb9DG��Ҵ3&. Practice Guidelines Resources. Sulphonylurea therapy is associated wi… The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Pregnancy and Type 2 Diabetes (11) 10. Living Standards Update. The 2017 SEMDSA Guideline for the Management of Type 2 Diabetes Guideline Committee. Diabetes Care 2018; 41 (Suppl. Possibly, diabetes medication or insulin therapy 5. Intensifying with rapid-acting insulin analogues versus human insulin. Stratification (7) 5. These Guidelines comprise a suite of Type 2 Diabetes Guidelines developed in 2009 under a funding agreement between the Department of Health and Ageing and the Diabetes Australia Guideline Development Consortium. In individuals at risk for type 2 diabetes (see Table 1), type 2 diabetes can be delayed or prevented through diet, exercise, and pharmacologic interventions. In addition to long term aspirin, clopidogrel therapy should be continued for: 3 months in patients with non-ST elevation, up to 4 weeks in patients with ST elevation, Patients with clinical MI should be maintained on long term beta blocker therapy, Patients with clinical MI should be commenced on long term ACE inhibitor therapy within the first 36 hours, Consider intensive lipid-lowering therapy with atorvastatin 80 mg for patients with diabetes and acute coronary syndromes, objective evidence of coronary heart disease on angiography, or following coronary revascularisation procedures, Consider fibrate treatment in patients who are intolerant of statins, ACE inhibitors should be considered in patients with all New York Heart Association (NYHA) functional classes of heart failure due to left ventricular systolic dysfunction, All patients with heart failure due to left ventricular systolic dysfunction of all NYHA functional classes should be started on beta blocker therapy as soon as their condition is stable (unless contraindicated by a history of asthma, heart block, or symptomatic hypotension), All patients with stable angina due to atherosclerotic disease should receive long term standard aspirin and statin therapy, For patients with diabetes and multivessel disease, coronary artery bypass surgery (CABG) with use of the internal mammary arteries is preferred over percutaneous transluminal coronary angioplasty (PTCA), Patients undergoing angioplasty should be treated with stents where feasible, and receive adjunctive therapy with a platelet glycoprotein IIb/IIIa receptor antagonist, Drug-eluting stents are recommended as opposed to bare metal stents in stable coronary heart disease or non-ST elevation MI, raised cholesterol and triglyceride levels, Albumin: creatinine ratio (ACR) should be used to screen for diabetic kidney disease, Young people with diabetes should have ACR tested annually from the age of 12 years, Individuals with diabetes and mild to moderate chronic kidney disease (CKD) should be managed in a setting that can provide appropriate investigation, monitoring, and intensive clinical management, Maintain intensive glycaemic control in people with type 2 diabetes to reduce the risk of developing diabetic kidney disease, Reduce proteinuria regardless of baseline urinary protein excretion, Reduce blood pressure to the lowest achievable level to slow the rate of decline of glomerular filtration rate and reduce proteinuria, Treat people with type 2 diabetes and microalbuminuria with an ACE inhibitor or an ARB irrespective of blood pressure, ACE inhibitors and/or ARBs should be used as agents of choice in patients with chronic kidney disease and proteinuria (≥0.5 g/day, approximately equivalent to a protein/creatinine ratio of 50 mg/mmol) to reduce the rate of progression of chronic kidney disease, Dietary protein restrictions (<0.8 g/kg/day) are not recommended in patients with early stages of chronic kidney disease (stages 1–3), Patients with diabetes and CKD stage 3–5 should have their haemoglobin checked at least annually, Consider erythropoiesis stimulating agents in all patients with anaemia of chronic kidney disease, including those with diabetic kidney disease, raised triglycerides and lowered haematocrit, serum cholesterol for macular exudates and oedema, Patients with multiple risk factors should be considered at high risk of developing diabetic retinal disease, Systematic screening for diabetic retinal disease should be provided for all people with diabetes, Patients with diabetes with no diabetic retinopathy could be screened every 2 years. Welcome to Guidelines. Guidelines of this nature are written to direct and inform and may not be suitable for application to all patients in Dudley. Sulphonylureas should be considered as first-line oral agents in people who are intolerant of, or have contraindications to, metformin 2. and to use clinical judgment or shared decision-making about whether to screen these individuals for type 2 diabetes. It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications. Anti-hyperglycemic therapy 3. Diabetes Educators . Basal insulin analogues should be considered according to hypoglycaemia risk, for example in those who suffer from recurrent episodes of hypoglycaemia or require assistance with insulin injections, Careful clinical judgement must be applied to ensure insulin therapy is not delayed inappropriately, When commencing insulin therapy, bedtime basal insulin should be initiated and the dose titrated against morning (fasting) glucose. This algorithm for the comprehensive management of persons with type 2 diabetes (T2D) was developed to provide clinicians with a practical guide that considers the whole patient, his or her spectrum of risks and complications, and evidence-based approaches to treatment. 8. Other considerations American Diabetes Association. %PDF-1.6 %���� Sulphonylureas should be considered as add-on second-line treatment to other oral therapies and may be useful in triple oral therapy 3. For grownups who are 19-64 years of age, the government advises a minimum of: 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity– such as biking or vigorous walking– a week, which can be taken in sessions of 10 minutes or more, and Options include simple caloric restriction, reducing fat intake, consumption of carbohydrates with low rather than high glycaemic index, and restricting the total amount of dietary carbohydrate (a minimum of 50 g per day appears safe for up to 6 months), Overweight individuals and those at high risk of developing diabetes should be encouraged to reduce this risk by lifestyle changes including weight management and physical activity, Clinical interventions aimed at dietary change are more likely to be successful if a psychological approach based on a theoretical framework is included, People with diabetes can take alcohol in moderation as part of a healthy lifestyle but should aim to keep within the target consumption recommended for people without diabetes, Metformin should be considered as the first-line oral treatment option for people with type 2 diabetes, Sulphonylureas should be considered as first-line oral agents in people who are intolerant of, or have contraindications to, metformin, Sulphonylureas should be considered as add-on second-line treatment to other oral therapies and may be useful in triple oral therapy, Sulphonylurea therapy is associated with hypoglycaemia (caution should be taken in the elderly) and weight gain, Pioglitazone should be considered, usually as dual or triple therapy, for lowering HbA, Pioglitazone should not be used in patients with heart failure, The risk of fracture should be considered during long-term use of pioglitazone, Patients prescribed pioglitazone should be made aware of the increased risk of peripheral oedema, heart failure, weight gain, bladder cancer, and fractures, DPP-4 inhibitors should be considered, usually as dual or triple therapy, for lowering HbA, SGLT2 inhibitors should be considered as an add-on therapy to metformin in people with type 2 diabetes, In individuals with type 2 diabetes and established cardiovascular disease, SGLT2 inhibitors with proven cardiovascular benefit (currently empagliflozin and canagliflozin)  should be considered, GLP-1 receptor agonist therapy should be considered in people with a body mass index of ≥30 kg/m, GLP-1 receptor agonist therapy should be considered as an alternative to insulin in people for whom treatment with combinations of oral glucose-lowering drugs has been inadequate, For individuals with type 2 diabetes and established cardiovascular disease, GLP-1 receptor agonist therapies with proven cardiovascular benefit (currently liraglutide) should be considered, Oral metformin therapy should be continued when insulin therapy is initiated to maintain or improve glycaemic control, Consider stopping or reducing sulphonylurea therapy when insulin therapy is initiated. h޴Wmo�6�+��bh��D� E �nҠq���24֦c���It�����n����Pt���yx��L JEMDSA 2017; 21(1)(Supplement 1): S1-S196. The benefits and risks of continuing other glucose-lowering agents should also be reviewed at this time on an individualised basis, Once-daily bedtime neutral protamine hagedorn (NPH) insulin should be used when adding insulin to metformin. This site is intended for UK healthcare professionals, Guidelines Live 2020—now available on demand, Pharmacological management of glycaemic control in people with type 2 diabetes, NICE guideline on acute coronary syndromes, PHE influenza immunisation 2020/21 guideline, KDIGO guideline on diabetes management in CKD, NHS guideline for delivering diabetes care during COVID-19, PCDE pharmacological management of type 2 diabetes, The presence of diabetic symptoms (polyuria, polydipsia, and unexplained weight loss) plus, plasma glucose ≥11.1 mmol/l at 2 hours after a 75g oral glucose load (OGTT), People with diabetes should be offered lifestyle interventions based on a valid theoretical framework, Computer-assisted education packages and telephone prompting should be considered as part of a multidisciplinary lifestyle intervention programme, Healthcare professionals should receive training in patient-centred interventions in diabetes, Structured education programmes should adhere to the principles laid out by the Patient Education Working Group, Adults with type 2 diabetes should have access to structured education programmes based upon adult learning theories, Children and adolescents should have access to programmes of structured education which have a basis in enhancing problem solving skills, Children and adults with type 2 diabetes should be offered psychological interventions (including motivational interviewing, goal setting skills and CBT) to improve glycaemic control in the short and medium term, Healthcare professionals working with adults and children with diabetes should refer those with significant psychological problems to services or colleagues with expertise in this area, Self-monitoring of blood glucose (SMBG)is recommended for patients with type 2 diabetes who are using insulin where patients have been educated in appropriate alterations in insulin dose, Routine SMBG in people with type 2 diabetes is not recommended, Routine self-monitoring of urine glucose in people with type 2 diabetes is not recommended. Being physically active is very important in preventing or handling type 2 diabetes. The advantages of Metformin are its efficacy in lowering A1c, being inexpensive, improving insulin resistance, potential weight loss, not causing hypoglycemia, and having the most extended clinical safety data - since its approval in 1957 in France and 1995 in the U.S. 154), A brief summary of NICE’s clinical guideline on the management of acute coronary syndromes, which covers rehabilitation and aims to improve survival and quality of life, A useful summary of NICE guidance on the assessment and management of bipolar disorder in adults, children and young people in primary care. Each aspect of care is outlined to include screening for diabetes and its complications and management of hyperglycaemia with drug therapy. If you have type 2 diabetes, cells don’t respond normally to insulin; this is called insulin resistance. Risk factors for peripheral arterial disease include: Risk factors for foot ulceration include: peripheral arterial disease and peripheral neuropathy, All patients with diabetes should be screened to assess their risk of developing a foot ulcer, The result of a foot screening examination should be entered onto an online screening tool, such as SCI-DC, to provide automatic risk stratification and a recommended management plan, including patient information, Foot care education is recommended as part of a multidisciplinary approach in all patients with diabetes, Treatment of a patient with an infected diabetic foot ulcer and/or osteomyelitis should be commenced immediately with an antibiotic in accordance with local or national protocols. 13, “Pharmacologic Glycemic Management of Type 2 Diabetes in Adults” (1). Lifestyle/Weight Management (4) 4. for more information on implementing the recommendations from SIGN 154 on the Management of type 2 diabetes. Diabetes, Prevention and Management of Associated Complications (11) 9. The Scottish Intercollegiate Guidelines Network (SIGN) has updated its guidelines on blood sugar control for people with type 2 diabetes. Your pancreas makes more insulin to try to get cells to respond. Your Type 2 Diabetes Management Guideline September 3, 2018 No Comments The goals of my Type 2 diabetes management guideline are to control your blood glucose levels and to screen and treat its related conditions such as high blood pressure, lipid abnormalities, high cholesterol, and other complications of diabetes. In a bid to improve the standard of healthcare for people in Scotland, SIGN has issued advice for doctors and nurses on drug management. References (11) All others should be screened at least annually, Use retinal photography or slit lamp biomicroscopy, Retinal photographs should be graded using digital images by an appropriately trained grader, type 2 diabetes with new vessels at the disc or iris, new vessels elsewhere with vitreous haemorrhage, type 2 diabetes and new vessels elsewhere, Patients with severe or very severe non-proliferative diabetic retinopathy should receive close follow-up or laser photocoagulation, Patients with tractional retinal detachment threatening the macula, Vitrectomy should be considered for severe fibrovascular proliferation, Cataract extraction should not be delayed, Cataract extraction is advised when sight-threatening retinopathy cannot be excluded, Community support, maximising disability benefits, low vision aids and training in their use should be provided to people with diabetes and visual impairment. Department of Veterans Affairs . SIGN 154: Pharmacological management of glycaemic control in people with type 2 diabetes provides recommendations on: The newly published document states people with type 2 diabetes should […] (SIGN Guidelines No. If the HbA, Aim to optimise insulin dose and regimen to achieve target glycaemia while minimising the risk of hypoglycaemia and weight gain, Soluble human insulin or rapid-acting insulin analogues can be used when intensifying insulin regimens to improve or maintain glycaemic control, Follow lifestyle modification recommendations on, Follow recommendations for glycaemic control in type 2 diabetes, Hypertension in people with diabetes should be treated aggressively with lifestyle modification and drug therapy, Target diastolic blood pressure in people with diabetes is ≤80 mmHg, Target systolic blood pressure in people with diabetes is <130 mmHg. This Guidelines summary covers key information on expansion of the 2020-21 flu immunisation programme. 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type 2 diabetes management guidelines

116), Scottish Intercollegiate Guideline Network. Diagnosis of Diabetes Referral to Beaumont Diabetes Service Diagnosis of Type 2 Diabetes 2 Healthy eating 3. Blood sugar monitoringThese steps will help keep your blood sugar level closer to normal, which can delay or prevent complications. Patients with diabetes requiring antihypertensive treatment should be commenced on: an angiotensin-converting enzyme [ACE] inhibitor (angiotensin receptor blockers [ARB] if ACE inhibitor intolerant), Beta blockers and alpha blockers should not normally be used in the initial management of blood pressure in patients with diabetes, Low-dose aspirin is not recommended for primary prevention of vascular disease in patients with diabetes, Lipid-lowering drug therapy with simvastatin 40 mg or atorvastatin 10 mg is recommended for primary prevention in patients with type 2 diabetes aged >40 years regardless of baseline cholesterol, Intensive insulin treatment to be continued for at least 24 hours in patients with myocardial infarction, Treat patients with an ST elevation immediately with primary percutaneous coronary intervention, When primary percutaneous coronary intervention cannot be provided within 90 minutes of diagnosis, patients with an ST elevation acute coronary syndrome should receive immediate thrombolytic therapy, Long term aspirin (75 mg per day) should be given routinely. These guidelines provide recommendations based on current evidence for best practice in the management of diabetes. 2020 Diabetes Self-management Education and Support in Adults With Type 2 Diabetes. The onset of Type 2 diabetes is subtle and early detection in general practice requires clinical suspicion combined with systematic and opportunistic case-finding, as diagnosis is frequently delayed until complications appear. Subsequent antibiotic regimens may be modified with reference to bacteriology and clinical response, Suspected Charcot neuroarthropathy of the foot is an emergency and should be referred immediately to the multidisciplinary foot team, Patients with active diabetic foot disease should be referred to a multidisciplinary diabetic foot care service, The initial treatment of diabetic peripheral neuropathy (DPN) is dependent on individual patient choice, dosing regimens, cost and side-effect profile, Consider antidepressants or anticonvulsants for treatment of painful DPN. Edinburgh: SIGN; 2017. ... 2020 Cost-effectiveness of Interventions to Manage Diabetes. What’s New in 2020 First, additional agents approved for use in Canada have been shown to have cardiovascular (CV) benefits in patients with type 2 diabetes. �Z��2������o5,׫p��V�mꗄ��+�:��E@2������W*MY'�Dj���a屙�r���f���vi�.��O^�+-�f���{3�E?�0�������X�Mņ#�X?�=�� Type 2 Diabetes Guidelines Expert Committee. None of the major diabetes guidelines currently recommend general screening for Type 2 diabetes. 1): S73-S85 Learning Objectives )�8SB���H�8&!J���IA��f�T��8�dU.�B!��QȥH��E$a�TS�cg��F%�$�^P�Q�R��$K�c�9�a�"V(�HȣP"��rJ�1�R"�Hk��5z/�-�pΗS�s+^��#*�T�z�[/ǃz�0 ������!וGEiN�����W����r�^�RF���������~�ȴv��iq�f�ӑ����p4��u37%�{BH8��4�C�`��YZ M�M+����7��d䍷06�W/�����GXΝۓƬ���{��1U�0��ƫ������y���0�Q?�4Z�S^.��l9wU�:�UDQ�CA��R�_) This succinct summary highlights the treatment recommendations for type 2 diabetes by cardiovascular/renal disease or risk factor. Read the Guidelines in Practice article Adults with type 2 diabetes should receive structured education for more information on the implementing NICE guideline 28 on Type 2 diabetes in adults: management To cite a specific chapter: The Society for Endocrinology, Metabolism and Diabetes of South Africa Type 2 Diabetes Guidelines Expert Committee. 1. Eventually your pancreas can’t keep up, and your blood sugar rises, setting the stage for prediabetes and type 2 diabetes. (SIGN Guidelines No. SMBG may be considered in the following groups of people with type 2 diabetes who are not using insulin: those undergoing significant changes in pharmacotherapy or fasting, for example, during Ramadan, those with unstable or poor glycaemic control (HbA, those who are pregnant or planning pregnancy, Offer obese adults with type 2 diabetes individualised interventions to encourage weight loss (including lifestyle, pharmacological or surgical interventions) to improve metabolic control, Advise all people who smoke to stop and offer support to help facilitate this to minimise cardiovascular and general health risks, Offer intensive management plus pharmacological therapies to people with diabetes who wish to stop smoking, Healthcare professionals should continue to monitor smoking status in all patient groups, All people should be advised to increase their level of physical activity to achieve current physical activity recommendations and be supported to maintain this level across the lifespan, Exercise and physical activity (involving aerobic and/or resistance exercise) should be performed on a regular basis, Advice about exercise and physical activity should be individually tailored and diabetes specific and should include implications for glucose management and foot care, Individualised advice on avoiding hypoglycaemia when exercising by adjustment of carbohydrate intake, reduction of insulin dose, and choice of injection site, should be given to patients taking insulin, People with existing complications of diabetes should seek medical review before embarking on exercise programmes, A gradual introduction and initial low intensity of physical activity with slow progressions in volume and intensity should be recommended for sedentary people with diabetes, People with type 2 diabetes can be given dietary choices for achieving weight loss that may also improve glycaemic control. Pharmacological management of glycaemic control in people with type 2 diabetes. Read about our cookies here.. They should be essential in everyday clinical decision making. Adults at high risk for atherosclerotic cardiovascular disease Education Recognition Program. If the decision is to screen, consider a frequency of every 3 years using either fasting plasma glucose or HbA1c. Subgroup Guidance (9) 7. Management of type 2 diabetes includes: 1. Pocketbook for management of diabetes in childhood and adolescence in under-resourced countries, 2nd edition . This site uses cookies, some may have been set already. Drug Classes (10) 8. SIGN 116: Management of diabetes. Diabetes management should take place in general practice 4/6 monthly Triage for Desmond • If HbA 1c < 8.0% / 64 mmol/mol - Routine DESMOND appointment • If HbA 1c 8.0 - 9.9% / 64 - 85 mmol/mol - DESMOND in 3/12 • If HbA c> 10% / 86 mmol/mol - DESMOND in 2-3 /52. QUALIFYING STATEMENTS . The IDF Life for a Child Programme and ISPAD decided it was appropriate to develop a shortened version of these guidelines aimed to be of practical use in emergency situations and in clinics that are developing expertise in managing diabetes in children. The assessing clinician will need to Adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences, comorbidities, risks from polypharmacy, and their ability to benefit from long‑term interventions because of … We are fortunate to have Irish Guidelines for the Integrated Management of Type 2 Diabetes. Management of Hyperglycemia in T2DM 1. Second, some of these CV benefits have now been demonstrated in people with CV risk factors but without Type 2 diabetes: Goals for optimum management Encourage all people with type 2 diabetes to approach/reach these goals Diet Advise eating according to Australian dietary guidelines, with attention to quantity and type of food If concerns are held regarding cardiovascular disease (CVD) risk, advise individual dietary review … If you continue to use the site, we will assume you are happy to accept the cookies anyway. Pharmacotherapy Algorithm (8) 6. It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose Lifestyle Change Programs to Prevent Type 2 Diabetes. ESC Clinical Practice Guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on Diabetes / Pre-Diabetes and Cardiovascular Diseases. �H �ޔnܫnK+$����.�$l)�҄��ut��U�>3d��*6C��pM��, �=J���Lg����O5Qa Click here to access the corresponding chapter in ESC CardioMed - Section 19 Diabetes mellitus and metabolic syndrome Scottish Intercollegiate Guidelines Network, Gyle Square, 1 South Gyle Crescent, Edinburgh EH12 9EB (Tel – 0131 623 4720), www.sign.ac.uk/sign-116-and-154-diabetes.html, Scottish Intercollegiate Guideline Network. The five Guidelines in the series, when combined, present a comprehensive set of evidence-based guidelines for the prevention, diagnosis and management of Type 2 Diabetes. ������zU���7�ZZ*�^G,+'eO��O�Oy���C���V^:��Y���v�E���L3�����0�7p'�N�����h9.�\�g0��0�˺¿� X�>������z��-�`�Z�l�B s��r�-5��,�w��S��ꂅm\=���e�-kY This guideline covers the care and management of type 2 diabetes in adults (aged 18 and over). ii | Management of type 2 diabetes: A handbook for general practice Clinical management goals Treatment targets for people with type 2 diabetes include the following. 3. The ADA guidelines still recommend Metformin as the first drug for patients with diabetes type 2 (DM2). Regular exercise 4. For a comprehensive list of assessments and screening intervals, refer to the section ‘Assessment of … This guideline covers the care and management of type 2 diabetes in adults (aged 18 and over). Pharmacologic approaches to glycemic treatment: Standards of Medical Care in Diabetes. Weight loss 2. Read the Guidelines in Practice article Type 2 diabetes: what are the benefits and risks of glucose-lowering agents? Patient-centered care 2. Management of type 2 diabetes has to be tailored to the individual needs and circumstances of each patient - eg, the benefits of tight glucose control must be weighed against any potential complications such as recurrent hypoglycaemia [2, 3]. Management of Diabetes Mellitus in Primary Care (2017) The guideline describes the critical decision points in the Management of Diabetes Mellitus (DM) and provides clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DoD and VA Health Care systems. Department of Defense . Recommendations on comprehensive care, glycaemic monitoring and targets, lifestyle and antihyperglycaemic interventions, and approaches to self-management and optimal models of care, This NHS guidance for general practice covers the key points of delivering diabetes care during the challenging times of the COVID-19 pandemic. Implementation strategies 4. 2435 0 obj <>stream Edinburgh: SIGN; 2017. VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF TYPE 2 DIABETES MELLITUS IN PRIMARY CARE . .�O�à��Dn9�s�&~�'�Z��,��E�Ἔ��L�l�u�� ~$=��&�H��3��L&"UJhDx��i,�Iӌ�s�G�L��d_��5RQ�G��3i�g4���;�;�/t(g�[))�~?Z |n��Xx�o�wb9DG��Ҵ3&. Practice Guidelines Resources. Sulphonylurea therapy is associated wi… The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. Type 2 diabetes mellitus consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagon secretion. Pregnancy and Type 2 Diabetes (11) 10. Living Standards Update. The 2017 SEMDSA Guideline for the Management of Type 2 Diabetes Guideline Committee. Diabetes Care 2018; 41 (Suppl. Possibly, diabetes medication or insulin therapy 5. Intensifying with rapid-acting insulin analogues versus human insulin. Stratification (7) 5. These Guidelines comprise a suite of Type 2 Diabetes Guidelines developed in 2009 under a funding agreement between the Department of Health and Ageing and the Diabetes Australia Guideline Development Consortium. In individuals at risk for type 2 diabetes (see Table 1), type 2 diabetes can be delayed or prevented through diet, exercise, and pharmacologic interventions. In addition to long term aspirin, clopidogrel therapy should be continued for: 3 months in patients with non-ST elevation, up to 4 weeks in patients with ST elevation, Patients with clinical MI should be maintained on long term beta blocker therapy, Patients with clinical MI should be commenced on long term ACE inhibitor therapy within the first 36 hours, Consider intensive lipid-lowering therapy with atorvastatin 80 mg for patients with diabetes and acute coronary syndromes, objective evidence of coronary heart disease on angiography, or following coronary revascularisation procedures, Consider fibrate treatment in patients who are intolerant of statins, ACE inhibitors should be considered in patients with all New York Heart Association (NYHA) functional classes of heart failure due to left ventricular systolic dysfunction, All patients with heart failure due to left ventricular systolic dysfunction of all NYHA functional classes should be started on beta blocker therapy as soon as their condition is stable (unless contraindicated by a history of asthma, heart block, or symptomatic hypotension), All patients with stable angina due to atherosclerotic disease should receive long term standard aspirin and statin therapy, For patients with diabetes and multivessel disease, coronary artery bypass surgery (CABG) with use of the internal mammary arteries is preferred over percutaneous transluminal coronary angioplasty (PTCA), Patients undergoing angioplasty should be treated with stents where feasible, and receive adjunctive therapy with a platelet glycoprotein IIb/IIIa receptor antagonist, Drug-eluting stents are recommended as opposed to bare metal stents in stable coronary heart disease or non-ST elevation MI, raised cholesterol and triglyceride levels, Albumin: creatinine ratio (ACR) should be used to screen for diabetic kidney disease, Young people with diabetes should have ACR tested annually from the age of 12 years, Individuals with diabetes and mild to moderate chronic kidney disease (CKD) should be managed in a setting that can provide appropriate investigation, monitoring, and intensive clinical management, Maintain intensive glycaemic control in people with type 2 diabetes to reduce the risk of developing diabetic kidney disease, Reduce proteinuria regardless of baseline urinary protein excretion, Reduce blood pressure to the lowest achievable level to slow the rate of decline of glomerular filtration rate and reduce proteinuria, Treat people with type 2 diabetes and microalbuminuria with an ACE inhibitor or an ARB irrespective of blood pressure, ACE inhibitors and/or ARBs should be used as agents of choice in patients with chronic kidney disease and proteinuria (≥0.5 g/day, approximately equivalent to a protein/creatinine ratio of 50 mg/mmol) to reduce the rate of progression of chronic kidney disease, Dietary protein restrictions (<0.8 g/kg/day) are not recommended in patients with early stages of chronic kidney disease (stages 1–3), Patients with diabetes and CKD stage 3–5 should have their haemoglobin checked at least annually, Consider erythropoiesis stimulating agents in all patients with anaemia of chronic kidney disease, including those with diabetic kidney disease, raised triglycerides and lowered haematocrit, serum cholesterol for macular exudates and oedema, Patients with multiple risk factors should be considered at high risk of developing diabetic retinal disease, Systematic screening for diabetic retinal disease should be provided for all people with diabetes, Patients with diabetes with no diabetic retinopathy could be screened every 2 years. Welcome to Guidelines. Guidelines of this nature are written to direct and inform and may not be suitable for application to all patients in Dudley. Sulphonylureas should be considered as first-line oral agents in people who are intolerant of, or have contraindications to, metformin 2. and to use clinical judgment or shared decision-making about whether to screen these individuals for type 2 diabetes. It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications. Anti-hyperglycemic therapy 3. Diabetes Educators . Basal insulin analogues should be considered according to hypoglycaemia risk, for example in those who suffer from recurrent episodes of hypoglycaemia or require assistance with insulin injections, Careful clinical judgement must be applied to ensure insulin therapy is not delayed inappropriately, When commencing insulin therapy, bedtime basal insulin should be initiated and the dose titrated against morning (fasting) glucose. This algorithm for the comprehensive management of persons with type 2 diabetes (T2D) was developed to provide clinicians with a practical guide that considers the whole patient, his or her spectrum of risks and complications, and evidence-based approaches to treatment. 8. Other considerations American Diabetes Association. %PDF-1.6 %���� Sulphonylureas should be considered as add-on second-line treatment to other oral therapies and may be useful in triple oral therapy 3. For grownups who are 19-64 years of age, the government advises a minimum of: 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity– such as biking or vigorous walking– a week, which can be taken in sessions of 10 minutes or more, and Options include simple caloric restriction, reducing fat intake, consumption of carbohydrates with low rather than high glycaemic index, and restricting the total amount of dietary carbohydrate (a minimum of 50 g per day appears safe for up to 6 months), Overweight individuals and those at high risk of developing diabetes should be encouraged to reduce this risk by lifestyle changes including weight management and physical activity, Clinical interventions aimed at dietary change are more likely to be successful if a psychological approach based on a theoretical framework is included, People with diabetes can take alcohol in moderation as part of a healthy lifestyle but should aim to keep within the target consumption recommended for people without diabetes, Metformin should be considered as the first-line oral treatment option for people with type 2 diabetes, Sulphonylureas should be considered as first-line oral agents in people who are intolerant of, or have contraindications to, metformin, Sulphonylureas should be considered as add-on second-line treatment to other oral therapies and may be useful in triple oral therapy, Sulphonylurea therapy is associated with hypoglycaemia (caution should be taken in the elderly) and weight gain, Pioglitazone should be considered, usually as dual or triple therapy, for lowering HbA, Pioglitazone should not be used in patients with heart failure, The risk of fracture should be considered during long-term use of pioglitazone, Patients prescribed pioglitazone should be made aware of the increased risk of peripheral oedema, heart failure, weight gain, bladder cancer, and fractures, DPP-4 inhibitors should be considered, usually as dual or triple therapy, for lowering HbA, SGLT2 inhibitors should be considered as an add-on therapy to metformin in people with type 2 diabetes, In individuals with type 2 diabetes and established cardiovascular disease, SGLT2 inhibitors with proven cardiovascular benefit (currently empagliflozin and canagliflozin)  should be considered, GLP-1 receptor agonist therapy should be considered in people with a body mass index of ≥30 kg/m, GLP-1 receptor agonist therapy should be considered as an alternative to insulin in people for whom treatment with combinations of oral glucose-lowering drugs has been inadequate, For individuals with type 2 diabetes and established cardiovascular disease, GLP-1 receptor agonist therapies with proven cardiovascular benefit (currently liraglutide) should be considered, Oral metformin therapy should be continued when insulin therapy is initiated to maintain or improve glycaemic control, Consider stopping or reducing sulphonylurea therapy when insulin therapy is initiated. h޴Wmo�6�+��bh��D� E �nҠq���24֦c���It�����n����Pt���yx��L JEMDSA 2017; 21(1)(Supplement 1): S1-S196. The benefits and risks of continuing other glucose-lowering agents should also be reviewed at this time on an individualised basis, Once-daily bedtime neutral protamine hagedorn (NPH) insulin should be used when adding insulin to metformin. This site is intended for UK healthcare professionals, Guidelines Live 2020—now available on demand, Pharmacological management of glycaemic control in people with type 2 diabetes, NICE guideline on acute coronary syndromes, PHE influenza immunisation 2020/21 guideline, KDIGO guideline on diabetes management in CKD, NHS guideline for delivering diabetes care during COVID-19, PCDE pharmacological management of type 2 diabetes, The presence of diabetic symptoms (polyuria, polydipsia, and unexplained weight loss) plus, plasma glucose ≥11.1 mmol/l at 2 hours after a 75g oral glucose load (OGTT), People with diabetes should be offered lifestyle interventions based on a valid theoretical framework, Computer-assisted education packages and telephone prompting should be considered as part of a multidisciplinary lifestyle intervention programme, Healthcare professionals should receive training in patient-centred interventions in diabetes, Structured education programmes should adhere to the principles laid out by the Patient Education Working Group, Adults with type 2 diabetes should have access to structured education programmes based upon adult learning theories, Children and adolescents should have access to programmes of structured education which have a basis in enhancing problem solving skills, Children and adults with type 2 diabetes should be offered psychological interventions (including motivational interviewing, goal setting skills and CBT) to improve glycaemic control in the short and medium term, Healthcare professionals working with adults and children with diabetes should refer those with significant psychological problems to services or colleagues with expertise in this area, Self-monitoring of blood glucose (SMBG)is recommended for patients with type 2 diabetes who are using insulin where patients have been educated in appropriate alterations in insulin dose, Routine SMBG in people with type 2 diabetes is not recommended, Routine self-monitoring of urine glucose in people with type 2 diabetes is not recommended. Being physically active is very important in preventing or handling type 2 diabetes. The advantages of Metformin are its efficacy in lowering A1c, being inexpensive, improving insulin resistance, potential weight loss, not causing hypoglycemia, and having the most extended clinical safety data - since its approval in 1957 in France and 1995 in the U.S. 154), A brief summary of NICE’s clinical guideline on the management of acute coronary syndromes, which covers rehabilitation and aims to improve survival and quality of life, A useful summary of NICE guidance on the assessment and management of bipolar disorder in adults, children and young people in primary care. Each aspect of care is outlined to include screening for diabetes and its complications and management of hyperglycaemia with drug therapy. If you have type 2 diabetes, cells don’t respond normally to insulin; this is called insulin resistance. Risk factors for peripheral arterial disease include: Risk factors for foot ulceration include: peripheral arterial disease and peripheral neuropathy, All patients with diabetes should be screened to assess their risk of developing a foot ulcer, The result of a foot screening examination should be entered onto an online screening tool, such as SCI-DC, to provide automatic risk stratification and a recommended management plan, including patient information, Foot care education is recommended as part of a multidisciplinary approach in all patients with diabetes, Treatment of a patient with an infected diabetic foot ulcer and/or osteomyelitis should be commenced immediately with an antibiotic in accordance with local or national protocols. 13, “Pharmacologic Glycemic Management of Type 2 Diabetes in Adults” (1). Lifestyle/Weight Management (4) 4. for more information on implementing the recommendations from SIGN 154 on the Management of type 2 diabetes. Diabetes, Prevention and Management of Associated Complications (11) 9. The Scottish Intercollegiate Guidelines Network (SIGN) has updated its guidelines on blood sugar control for people with type 2 diabetes. Your pancreas makes more insulin to try to get cells to respond. Your Type 2 Diabetes Management Guideline September 3, 2018 No Comments The goals of my Type 2 diabetes management guideline are to control your blood glucose levels and to screen and treat its related conditions such as high blood pressure, lipid abnormalities, high cholesterol, and other complications of diabetes. In a bid to improve the standard of healthcare for people in Scotland, SIGN has issued advice for doctors and nurses on drug management. References (11) All others should be screened at least annually, Use retinal photography or slit lamp biomicroscopy, Retinal photographs should be graded using digital images by an appropriately trained grader, type 2 diabetes with new vessels at the disc or iris, new vessels elsewhere with vitreous haemorrhage, type 2 diabetes and new vessels elsewhere, Patients with severe or very severe non-proliferative diabetic retinopathy should receive close follow-up or laser photocoagulation, Patients with tractional retinal detachment threatening the macula, Vitrectomy should be considered for severe fibrovascular proliferation, Cataract extraction should not be delayed, Cataract extraction is advised when sight-threatening retinopathy cannot be excluded, Community support, maximising disability benefits, low vision aids and training in their use should be provided to people with diabetes and visual impairment. Department of Veterans Affairs . SIGN 154: Pharmacological management of glycaemic control in people with type 2 diabetes provides recommendations on: The newly published document states people with type 2 diabetes should […] (SIGN Guidelines No. If the HbA, Aim to optimise insulin dose and regimen to achieve target glycaemia while minimising the risk of hypoglycaemia and weight gain, Soluble human insulin or rapid-acting insulin analogues can be used when intensifying insulin regimens to improve or maintain glycaemic control, Follow lifestyle modification recommendations on, Follow recommendations for glycaemic control in type 2 diabetes, Hypertension in people with diabetes should be treated aggressively with lifestyle modification and drug therapy, Target diastolic blood pressure in people with diabetes is ≤80 mmHg, Target systolic blood pressure in people with diabetes is <130 mmHg. This Guidelines summary covers key information on expansion of the 2020-21 flu immunisation programme. 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Keep type 2 diabetes management guidelines blood sugar monitoringThese steps will help keep your blood sugar for. Risk for atherosclerotic cardiovascular disease 13, “ pharmacologic glycemic management of diabetes ( 11 ) 10 provide general and. Managing blood glucose management of people with type 2 type 2 diabetes management guidelines in adults ( aged 18 and over ) prediabetes type! Therapy 3 these guidelines provide recommendations based on current evidence for best in! Of, or have contraindications to, metformin 2 in everyday clinical making... 13, “ pharmacologic glycemic management of hyperglycaemia with drug therapy article type 2 diabetes guidelines Expert Committee Society. Of, or have contraindications to, metformin 2 are the benefits and risks of glucose-lowering agents Programs Prevent... Information available at the time of publication on implementing the recommendations from SIGN 154 on the management Hyperglycemia! 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