B, 8.6 Nutrition, physical activity, and behavioral therapy to achieve and maintain 5% weight loss are recommended for most people with type 2 diabetes and overweight or obesity. Terms of Use and Privacy Policy Conditions of Use. Pharmacologic Approaches to Glycemic Treatment in the complete 2023 Standards of Care for detailed information on pharmacologic approaches to type 1 diabetes management. A, 10.3 For people with diabetes and hypertension, BP targets should be individualized through a shared decision-making process that addresses CV risk, potential adverse effects of antihypertensive medications, and patient preferences. B, 11.8 Patients should be referred for evaluation by a nephrologist if they have continuously increasing urinary albumin levels and/or continuously decreasing eGFR and if the eGFR is <30 mL/min/1.73 m2. After the onset of puberty or after 10 years of age, whichever occurs earlier. Promote increase in nonsedentary activities above baseline for sedentary individuals with type 1 diabetes E and type 2 diabetes. B, 10.46 Treatment of individuals with HFrEF should include a -blocker with proven CV outcomes benefit, unless otherwise contraindicated. HF is another major cause of morbidity and mortality from CVD. Nearly all of these medications can improve glycemia in addition to weight loss for people with type 2 diabetes. Venue: San Diego Convention Center, San Diego, USA B, 13.4 Because older adults with diabetes have a greater risk of hypoglycemia than younger adults, episodes of hypoglycemia should be ascertained and addressed at routine visits. Tour de Cure is the premier fundraising campaign of the American Diabetes Association , now with virtual engagement designed for anyone and everyone to participate. Clinical signals that may prompt evaluation of overbasalization include basal dose more than 0.5 units/kg/day, high bedtimemorning or post- to preprandial glucose differential, hypoglycemia (aware or unaware), and high glycemic variability. B, 8.22 People who undergo metabolic surgery should receive long-term medical and behavioral support and routine micronutrient, nutritional, and metabolic status monitoring. E, 10.41 Among people with type 2 diabetes who have established ASCVD or established kidney disease, an SGLT2 inhibitor or GLP-1 receptor agonist with demonstrated CVD benefit (see Tables 10.3B and 10.3C in the complete 2023 Standards of Care) is recommended as part of the comprehensive CV risk reduction and/or glucose-lowering regimens. A. DKD is diagnosed based on the presence and degree of albuminuria and/or reduced eGFR in the absence of symptoms of other primary causes of kidney damage. Not every patient will clearly fall into a particular category. A, 11.5b For people with type 2 diabetes and DKD, use of an SGLT2 inhibitor is recommended to reduce CKD progression and CV events in patients with an eGFR 20 mL/min/1.73 m2 and urinary albumin ranging from normal to 200 mg/g creatinine. Risk-Based Screening for Type 2 Diabetes or Prediabetes in Asymptomatic Children and Adolescents in a Clinical Setting. E. Diabetes confers significantly greater maternal and fetal risk largely related to the degree of hyperglycemia but also related to chronic complications and comorbidities of diabetes. The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. By continuing to use our website, you are agreeing to, Justice, Equity, Diversity, and Inclusion, Institutional Subscriptions and Site Licenses, 1. GLP-1 receptor agonists and SGLT2 inhibitors have CV and renal benefits that extend to older adults, although class-specific side effects may limit their use. A, 10.8 Individuals with confirmed office-based BP 160/100 mmHg should, in addition to lifestyle therapy, have prompt initiation and timely titration of two drugs or a single-pill combination of drugs demonstrated to reduce CV events in people with diabetes. The classification of diabetes type is not always straightforward at presentation, and misdiagnosis may occur. The ADA and the European Association for the Study of Diabetes published a consensus report on precision diabetes medicine in 2020. People with diabetes should be prioritized and offered SARS-CoV-2 vaccines. To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, to improve overall health and: Attain individualized glycemic, blood pressure (BP), and lipid goals, To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful foods, willingness and ability to make behavioral changes, and existing barriers to change, To maintain the pleasure of eating by providing nonjudgmental messages about food choices while limiting food choices only when indicated by scientific evidence, To provide an individual with diabetes the practical tools for developing healthy eating patterns rather than focusing on individual macronutrients, micronutrients, or single foods. E, 10.18 For people with diabetes aged 4075 years without ASCVD, use moderate-intensity statin therapy in addition to lifestyle therapy. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes2023 Summary of Revisions: Standards of Care in Diabetes2023 International Tables of Glycemic Index and Glycemic Load Values: 2008 If the cancellation is made after the start of the activity, no refund will be issued. A, 11.4b Periodically monitor serum creatinine and potassium levels for the development of increased creatinine and hyperkalemia when ACE inhibitors, ARBs, and MRAs are used, or hypokalemia when diuretics are used. A lower A1C goal may be set for an individual if achievable without recurrent or severe hypoglycemia or undue treatment burden. Nama: Ada 2023 Conference: Kategori: Apps: Ukuran: Bervariasi: Versi: Versi Terbaru: Jenis File: Apk, Data, Mod . B, 10.21 For people with diabetes aged 4075 years at higher CV risk, especially those with multiple ASCVD risk factors and an LDL cholesterol 70 mg/dL, it may be reasonable to add ezetimibe or a PCSK9 inhibitor to maximum tolerated statin therapy. Two of three specimens of UACR collected within a 3- to 6-month period should be abnormal before considering a patient to have albuminuria. C, 7.5 Initiation of CGM, CSII, and/or AID early in the treatment of diabetes can be beneficial depending on a persons/caregivers needs and preferences. Screening criteria for adults and children are listed in Table 2.3 and Table 2.4, respectively. Other Healthcare ProfessionalsA record of attendance will be provided to all registrants for requesting credits in accordance with state nursing boards, specialty societies or other professional associations. Hypertension, defined as a systolic BP 130 mmHg or a diastolic BP 80 mmHg, is common among people with either type 1 or type 2 diabetes. The American Diabetes Association (ADA) has released their updated Standards of Care for 2023 with the goal of providing the diabetes care team within an overview of diabetes management, including updates in diabetes technology, obesity, hypertension, heart failure medication, and lipid management. 4. Number of days CGM device is worn (recommend 14 days), 2. The concern that lipid-lowering agents may adversely affect cognitive function is not currently supported by evidence and should not deter their use. 7.15 In people with diabetes on MDI or CSII, rtCGM devices should be used as close to daily as possible for maximal benefit. . 5.30 Adults with type 1 diabetes C and type 2 diabetes B should engage in 23 sessions/week of resistance exercise on nonconsecutive days. A. C, 10.25 For people of all ages with diabetes and ASCVD, high-intensity statin therapy should be added to lifestyle therapy. A, 3.7 Long-term use of metformin may be associated with biochemical vitamin B12 deficiency; consider periodic measurement of vitamin B12 levels in metformin-treated individuals, especially in those with anemia or peripheral neuropathy. Risk factors, including obesity/overweight, hypertension, dyslipidemia, smoking, family history of premature coronary disease, CKD, and the presence of albuminuria, should be assessed at least annually to prevent and manage both ASCVD and HF. Reprinted from Holt RIG, DeVries JH, Hess-Fischl A, etal. If you are interested in being an exhibitor or featured sponsor, send an email to our CNE conference coordinator Megan Hylland. E, 6.2 Assess glycemic status at least quarterly and as needed in patients whose therapy has recently changed and/or who are not meeting glycemic goals. A Other oral and noninsulin injectable glucose-lowering medications lack long-term safety data. The choice of device should be made based on the individuals circumstances, preferences, and needs. Management of glycemia, BP, and lipids can reduce the risk or slow the progression of microvascular complications of diabetes. are available near the San Diego Convention Center, San Diego, USA. Consideration of patient and caregiver preferences is an important aspect of treatment individualization. Impact of a Pharmacist-Led Diabetes Care Service for Hispanic Patients at a Free Medical Clinic, Personalized Virtual Care Using Continuous Glucose Monitoring in Adults With Type 2 Diabetes Treated With Less Intensive Therapies, Severe Hypoglycemia and the Use of Glucagon Rescue Agents: An Observational Survey in Adults With Type 1 Diabetes, Human Insulin as an Antidote to the High Cost of Insulin: Clinical Insignificance of Pharmacokinetic/Pharmacodynamic Differences, 1. An ADA resource available at consumerguide.diabetes. 16.6 Basal insulin or a basal plus bolus correction insulin regimen is the preferred treatment for noncritically ill hospitalized patients with poor oral intake or those who are taking nothing by mouth. B. Strict glucose and BP control are not necessary E, and simplification of regimens can be considered. eGFR should be monitored while taking metformin, which can be used in patients with eGFR 30 mL/min/1.73 m2. 8.1 Use person-centered, nonjudgmental language that fosters collaboration between individuals and HCPs, including person-first language (e.g., person with obesity rather than obese person). A, Evaluate for diabetes complications, potential comorbid conditions, and overall health status. Click Below For Official Website, Also Get the Hotel Options Near Convention Center. Shopping Cart A, 13.24 Overall comfort, prevention of distressing symptoms, and preservation of QoL and dignity are primary goals for diabetes management at the end of life. B, 11.5c In people with type 2 diabetes and DKD, consider use of SGLT2 inhibitors (if eGFR is 20 mL/min/1.73 m2), a GLP-1 receptor agonist, or a nonsteroidal MRA (if eGFR is 25 mL/min/1.73 m2) additionally for CV risk reduction. American College of CardiologyDesignated Representatives (Section 10) include Sandeep R. Das, MD, MPH, FACC, and Mikhail Kosiborod, MD, FACC, FAHA. Powered by the EthosCE Learning Management System, a continuing education LMS. A Larger, sustained weight losses (>10%) usually confer greater benefits, including disease-modifying effects and possible remission of type 2 diabetes, and may improve long-term CV outcomes and mortality. 5.29 Most adults with type 1 diabetes C and type 2 diabetes B should engage in 150 minutes or more of moderate- to vigorous-intensity aerobic activity per week, spread over at least 3 days/week, with no more than 2 consecutive days without activity. eGFR should be calculated from serum creatinine using a validated formula. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. Although CGM has theoretical advantages over POC glucose monitoring in detecting and reducing the incidence of hypoglycemia, it has not been approved by the FDA for inpatient use. The Diabetes Management 2023 CNE conference is designed to provide an overview of diabetes management including updates to the 2023 ADA Standards of Care, implementing ADA recommendations and algorithms in clinical practice, advances in diabetes technology, patient education, nutrition, cardiovascular and mental health living with diabetes, and C, 3.11 In adults with overweight/obesity at high risk of type 2 diabetes, care goals should include weight loss or prevention of weight gain, minimizing the progression of hyperglycemia, and attention to CV risk and associated comorbidities. As an Approved Provider for CBDCE, these contact hours are applicable to CDCES renewal. C. In hospitalized individuals with diabetes who are eating, point-of-care (POC) glucose monitoring should be performed before meals; in those not eating, glucose monitoring is advised every 46 hours. B, 13.16 Overtreatment of diabetes is common in older adults and should be avoided. When caring for hospitalized people with diabetes, consult with a specialized diabetes or glucose management team when possible. Maternal history of diabetes or GDM during the childs gestation, Family history of type 2 diabetes in first- or second-degree relative, Race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander), Signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or small-for-gestational-age birth weight), 1. A, 13.15 In older adults with type 2 diabetes at increased risk of hypoglycemia, medication classes with low risk of hypoglycemia are preferred. DIABETES CARE IN THE HOSPITAL in the complete 2023 Standards of Care for guidance on enteral/parenteral feedings, glucocorticoid therapy, perioperative care, and DKA and hyperosmolar hyperglycemic state. B, 10.6 For people with BP >120/80 mmHg, lifestyle intervention consists of weight loss when indicated, a Dietary Approaches to Stop Hypertension (DASH)-style eating pattern including reducing sodium and increasing potassium intake, moderation of alcohol intake, and increased physical activity. Episodes of hypoglycemia in the hospital should be documented in the medical record and tracked for quality improvement/quality assessment. E, 6.14 Insulin-treated patients with hypoglycemia unawareness, one level 3 hypoglycemic event, or a pattern of unexplained level 2 hypoglycemia should be advised to raise their glycemic targets to strictly avoid hypoglycemia for at least several weeks in order to partially reverse hypoglycemia unawareness and reduce risk of future episodes. 6.5a An A1C goal for many nonpregnant adults of <7% (53 mmol/mol) without significant hypoglycemia is appropriate. 10.1 BP should be measured at every routine clinical visit. The safety and efficacy of noninsulin glucose-lowering therapies in the hospital setting is an area of active research. If an individual has a test result near the margins of the diagnostic threshold, the clinician should follow that person closely and repeat the test in 36 months. E. Table 6.2 summarizes CGM-derived glycemic metrics, and Table 7.3 defines the available types of CGM devices. A, 8.21 People being considered for metabolic surgery should be evaluated for comorbid psychological conditions and social and situational circumstances that have the potential to interfere with surgery outcomes. The recommendations, tables, and figures included here retain the same numbering used in the complete Standards of Care. All of the recommendations included here are substantively the same as in the complete Standards of Care. A Individuals with BP 180/110 mmHg and CVD could be diagnosed with hypertension at a single visit. 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