New Diabetes Guidelines
The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) updated their Comprehensive Diabetes Management Algorithm and Executive Summary to guide clinicians in management of type 2 diabetes. The algorithm facilitates development of individualized patient management plans; establishment and maintenance of optimal glycated hemoglobin (HbA1c) and Glycemic control targets; minimization of weight gain and associated complications and management of type 2 diabetes comorbidities including insulin resistance, macrovascular and microvascular complications, hypertension, cardiovascular disease and lipid disorders.
- Multifaceted, ongoing, lifestyle optimization for all patients involves the entire diabetes team. This should not delay needed pharmacotherapy; medications can be started simultaneously and adjusted based on response to lifestyle intervention.
- HbA1c target (≤6.5% optimal if achieved safely) should be individualized based on age, life expectancy, comorbidities, diabetes duration, hypoglycemic risk, patient motivation, adherence, and other factors.
- Glycemic control targets include self-monitoring of blood glucose.
- Patient-related and medication-related factors (efficacy; mechanism; hypoglycemic risk; weight gain; adverse effects; tolerability; ease of use; adherence; cost; and safety in heart, kidney, or liver disease) should guide pharmacotherapy.
- To minimize or prevent hypoglycemia and its serious sequelae, safety is the top priority for any antidiabetic therapy.
- Minimizing the risk for weight gain is also a priority.