Today I am just going to go through some of the main recommendations of the ADA's Latest 2015 Guidelines for Diabetics.
First
The cut-off point for screening Asians & Indians in terms of their BMI is now 23 instead of 25, and this is because Asians & Indians develop diabetes or a risk for diabetes at a lower BMI than non-Asians. It is important to know that and to screen at a lower BMI.
Second
They recommend that people be more physically active during the day, particularly people who are sitting for 90 or more minutes at a time. They recommend that people get up and move around, which I personally think is a very good idea because we all sit too much at work and therefore don't get enough daily activity.
Third
They suggest that e-cigarettes have not been proven to be useful either in smoking cessation or as a safe alternative to cigarettes. So they DO NOT suggest e-cigarettes as an alternative for smoking cessation or as an alternative to regular cigarettes.
Fourth
They also raise the diastolic blood pressure target from 80 to 90. And in terms of glycemia, the old pre-meal target was 70 to 130, and they have raised that to 80 to 130, which I think is a good thing. Many patients, particularly aged ones and those on insulin, need to avoid hypoglycemia below 70.
Fifth
Now the lipid guidelines: Basically, the ADA follows the ACC/AHA recommendations but they do not use a risk calculator as they do in the cardiology recommendations.
So first of all, divide patients into two groups: those who are younger than 40 years of age and those who are 40 years of age or older.
Basically, everybody who is above 40 years of age is going to be on a statin, and the choice is going to be whether it is a moderate-intensity statin or a higher-intensity statin. For the most part, those on a moderate-intensity statin are going to be those who really don't have much in the way of other risk factors. Those on a high-intensity statin will be those with risk factors, as well as those who have had a cardiovascular disease event.
When you look at individuals younger than 40 years of age, you want to look at whether an individual has risk factors.
The risk factors that are listed are : [1] an LDL cholesterol above 100, [2] being overweight or obese, [3] cigarette smoking, and [4] hypertension.
Those are all individuals who, even though younger than 40 years, should also be on a moderate-intensity statin. And obviously, anyone who has had a cardiovascular disease event before the age of 40 needs to be on a statin as well.
Now, all of that sounds simple and easy to implement, So, a lipid panel is recommended at baseline and then periodically thereafter to assess for adherence and to see what is happening to the LDL cholesterol level.
Life Style Management :
The other key component of this is that they do stress (and I always stress) the role of lifestyle. People, by changing their diet, can effectively lower their cholesterol levels. I think that is very important to encourage as patients are put on medications for the treatment of their elevated lipid levels.
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