The clinical practice recommendations by American Diabetes Association are available in a publication which comes out in the month of January every year. This information is available on their site too and you can get it from there free of cost. The American Diabetes Association Guidelines 2011 are not much different from previous guidelines. Hence, the doctors need not to change the way they practice that much. The guidelines of 2011 differ in terms of screening for gestational diabetes.
Picture 1: Symbol of American Diabetes Association
Source: diabetes.org
Cutpoints of American Diabetes Association Guidelines
- The fasting cutpoint is equal to or greater than 92 mg/dL
- The hourly cutpoint is equal to or greater than 180 mg/dL
- The 2-hour cutpoint is equal to or greater than 153 mg/dL
In case, a woman is above these cutpoints, she needs to be diagnosed with gestational diabetes. Every woman, who had gestational diabetes in the past, must be screened at least once every three years to ensure the type2 diabetes do not develop in future.
Targets
The targets are still applicable as they were in previous guidelines. The doctors had a number of clinical trials since last some years that had led to confusing data regarding the safety of normalizing the levels of blood glucose in human body. However, the current target of A1c level was only 7% that seemed far less from reasonable target. The risk of microvascular complications like nephropathy, retinopathy and neuropathy reduce significantly with increase in normal blood glucose level. There is reduction in macrovascular complications if tight glucose control is started at the initial stages of diagnosis.
Hypoglycaemia
Doctors should individualise the care they give to their patients. A person who is in 40s or 50s can get to A1c level of even less than 6% without excessive hypoglycaemia is doing well enough. Such persons are great target. However, older patients who are on insulin, or who are trying their best but still develop hypoglycaemia cannot do better than haemoglobin A1c of 7.5% or 8%. Such patients are given higher target to protect from any harm, especially severe hypoglycaemia.
Glucose Levels
Along with glucose levels, other levels were also validated. The target for blood pressure is less than 130/80 [mm Hg]. The target for low density lipoprotein (LPL) is less than 100 mg/dL, provided the patient do not has any known cardiovascular disease. In that case, it is 70 mg/dL.
In gestational diabetes, the 50-gram screen is going away and 100-gram glucose tolerance test has taken the place. All pregnant ladies are recommended a 75-gram 2-hour glucose tolerance test during 24-28 weeks of gestation. Blood for glucose tolerance test should be drawn from the baseline at 1 hour and at 2 hours. Only a single abnormal value is required from a pregnant woman to be diagnosed with gestational diabetes.
Adult Care
Another area touched by the American Diabetes Association Guidelines 2011 is the notion of care for transitioning adult. Young people who are between the ages of 18-30 years are not yet neither full adults, nor they are children. Majority of such patients who develop diabetes in childhood, it is important to leave paediatrician behind and start getting diagnosis from adult’s doctor. During the transition phase, many patients of transition phase tend to get lost and do not get properly diagnosed for diabetes problem. The American Diabetes Association will soon release guidelines for the treatment of transitioning patients.
These were the clinical guidelines issued by The American Diabetes Association during the year 2011.
Reference
The American Diabetes Association - http://www.diabetes.org
The Internet Journal – http://www.ispub.com
by on 19. Sep, 2011 in diabetes information
Back to Top