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T2DM management

ACCE publishes Diabetes Management Algorithm

Provides suggestions for treatment prioritisation and risk-reduction strategies

The American Association of Clinical Endocrinologists (AACE) has published a new comprehensive diabetes management algorithm guide primary care physicians, endocrinologists and other health care professionals in the treatment of prediabetes and type 2 diabetes mellitus patients.

“This algorithm is a definitive, point-of-care tool for clinicians engaged in the treatment of those who are at risk for or have developed diabetes,” said Dr Alan Garber, chair of the algorithm task force and President of AACE. “We have expanded on our previous efforts to address broad-reaching, critical factors that accompany the disease and its treatment.”

The AACE Comprehensive Diabetes Management Algorithm 2013 provides suggestions for treatment prioritisation and risk-reduction strategies while addressing circumstances and conditions that frequently are precursors to, or are concurrent with, type 2 diabetes diagnosis.

This includes:

  • Management of diabetes and co-existing diseases or disorders in the prediabetic phase of disease.
  • A hierarchy of steps for the management of high blood sugar control using an approach that balances age and comorbidities while minimizing the adverse effects of hypoglycemia and weight gain.
  • Complications-centric treatment of the overweight or obese patient, as opposed to a BMI-centric approach, including medical and surgical treatments for greater weight loss.
  • Management of cardiovascular disease risk factors, hypertension and hyperlipidemia in those patients with prediabetes type 2 diabetes.

Among the algorithm's key recommendations is a comprehensive care plan for persons with diabetes, which must now consider obesity management as an integral part of the overall treatment plan to effectively reduce morbidity, mortality and disability in the majority of patients with type 2 diabetes who are obese.

The paper suggests a blood sugar goal of less than 6.5% A1c as optimal for most diabetes patients if it can be achieved in a safe manner, and the algorithm recommends the target be individualised based on numerous factors such as age, comorbid conditions, duration of diabetes, risk of hypoglycaemia, patient motivation and adherence, and life expectancy. Higher targets may be appropriate for some individuals and may change for a given individual over time.

The algorithm also includes every FDA-approved class of medications for diabetes and differentiates the choice of therapies based on the patient's initial A1C.

"With more than 100 million suffering from diabetes and prediabetes in the United States, there simply are not enough endocrinologists to care for all patients," said Garber. "Thus, this algorithm is essential to assist and educate clinicians who are charged with these patients' care."

The algorithm is also the first to recommend active obesity management, which includes lifestyle modification and, if appropriate, the use of FDA-approved anti-obesity medications, as first-line therapy in the management of chronic cardiometabolic diseases, including prediabetes, diabetes, dyslipidemia and hypertension.

"As a respected and influential institution in the field of endocrinology, it is encouraging to see the AACE has addressed the critical role of effective medical obesity treatments in the management of chronic cardiometabolic disease," said Peter Tam, president of VIVUS. "We believe that healthcare providers, including primary care physicians, along with payers and public policy makers, will recognise the significance of these new guidelines."

The guidelines are available online and in the March/April 2013 issue of Endocrine Practice and can be accessed here.

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