The definition of hypertension in diabetes of 140/90 mm Hg, has been maintained by the association different from cardiological societies that have lowered the standard guidelines to >130/80 mm Hg representing “stage 1 Hypertension” in diabetes.Glucose-lowering drugs with proven cardiovascular benefits and/or mortality reduction drugs similar to Victoza Novo Nordisk (GLP-1) glucagonlike peptide 1 agonist liraglutide and Jardiance, Boehringer Ingelheim/Lilly and (SGLT2) sodium glucose contransporter-2 inhibitor empagliflozin have had an impact in diabetic patients with known atherosclerotic cardiovascular disease who do not meet glucose targets with previous metformin use or/and lifestyle modification.
ADA´s chief scientific, medical, and mission officer William T Cefalu, MD has stated that we now can include new drugs that can not only improve glycemic control but as well reduce cardiovascular risk and mortality rates. Based on the new trails in cardiovascular outcomes new recommendations have been added for adult type 2 diabetes who consequently fail therapy with metformin when in medical history a cardiovascular and atherosclerotic disease has been found. Dr. Cefalu also added in an American Diabetes Association statement summarizes the most influential changes prior to the guidelines
Recent ardiovascular-outcomes studies and details brought by these recommendations are outlined in a new table and figure details. For the new recommendations different factors have been taken into consideration for an adequate and effective diabetes treatment such as hypoglycemia secondary to glucose-lowering drugs, weight effects, kidney effects, and costs for diabetes medication, to improve the patient-provider decision- making that best suits every patient Evidence-based prevention of diabetes and its complications are the primary reason why the standards of care have been updated to enhance an optimal and preferential management. The new updates in 2018 American Diabetes Association´s Standards of Medical Care in Diabetes were published online December 8, 2017 in Diabetes Care. The 173 pages were made in conjunction with different members from the American Diabetes Association (12- member writing panel) led by Rita R. Kalyani, MD, John Hopkins School of Medicine, from Baltimore, Maryland.
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Use of HbA1c, Glucose screening in Kids and Elderly
Screening for prediabetes and type 2 diabetes in overweight and obese children and adolescents with one or more additional risk factors has been a new major recommendation added in the new ADA guidelines. The difference in adult type 2 diabetes is visibly different from preadolescent type 2 diabetes. A more rapid decrease in beta-cell function has been noted. Sickle- cell anemia and other conditions affecting red blood cell turnover patients have notoriously seen a limitation in tests regarding the use of HbA1c for screening, diagnosis, or monitoring of diabetes. The use of continuous glucose monitoring (CGM) should now be used by all adults over 18 years with type 1 diabetes who do not meet required glycemic targets (Pediatric recommendation is still pending). ADA guidelines as well advise individualization in blood-pressure management based on patients and known comorbidities to evaluate the patient.
Added as well is a new recommendation that pregnant women with preexisting type 1 or 2 type should be prescribed with a daily low-low dose aspirin after first trimester for reduction of preeclampsia risk.