Οι Nέες Kατευθυντήριες Oδηγίες για τον Σακχαρώδη Διαβήτη 2018 της Ε.Δ.Ε. »»
Οι νέες κατευθυντήριες οδηγίες για τη διαχείριση του διαβητικού ασθενούς 2018
This algorithm for the comprehensive management of persons with type 2 diabetes (T2D) was developed to provide clinicians with a practical guide that considers the whole patient, his or her spectrum of risks and complications, and evidence-based approaches to treatment. It is now clear that the progressive pancreatic beta-cell defect that drives the deterioration of metabolic control over time begins early and may be present before the diagnosis of diabetes (1). In addition to advocating glycemic control to reduce microvascular complications, this document high lights obesity and prediabetes as underlying risk factors for the development of T2D and associated macrovascular complications. In addition, the algorithm provides recommendations for blood pressure (BP) and lipid control, the two most important risk factors for cardiovascular disease (CVD).
Επιμελητής Α’ ΕΣΥ
Παθολόγος με εξειδίκευση στο Διαβήτη και στο Διαβητικό Πόδι
Ιατρεία: Αγρίνιο και Λάρισα
Αναρτήθηκε online η νέα έκδοση της εφαρμογής υπολογισμού του κινδύνου για σακχαρώδη διαβήτη QDiabetes-2018.
Στην νέα έκδοση του web-calculator έχουν ενσωματωθεί “νεότεροι” παράγοντες κινδύνου (πχ χρήση στατινών ή άτυπων αντιψυχωσικών, σύνδρομο πολυκυστικών ωοθηκών, κλπ).
Προσοχή! Δεν έχουν γίνει μελέτες χρήσης αξιοπιστίας της εφαρμογής για άτομα εκτός της Μ. Βρετανίας.
Δείτε επίσης: Εφαρμογές για τον Σακχαρώδη Διαβήτη
Δημοσιεύτηκαν οι νέες συστάσεις για τον Σακχαρώδη Διαβήτη – 2018 από την Αμερικανική Διαβητολογική Εταιρεία (ADA) »»
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The field of diabetes care is rapidly changing as new research, technology, and treatments that can improve the health and well-being of people with diabetes continue to emerge. With annual updates since 1989, the American Diabetes Association’s (ADA’s) “Standards of Medical Care in Diabetes” (Standards of Care) has long been a leader in producing guidelines that capture the most current state of the field. Starting in 2018, the ADA will update the Standards of Care even more frequently online should the Professional Practice Committee determine that new evidence or regulatory changes merit immediate incorporation into the Standards of Care. In addition, the Standards of Care will now become the ADA’s sole source of clinical practice recommendations, superseding all prior position and scientific statements. The change is intended to clarify the Association’s current positions by consolidating all clinical practice recommendations into the Standards of Care.
ΣΥΝΟΨΗ ΟΡΙΣΜΕΝΩΝ ΣΗΜΑΝΤΙΚΩΝ ΑΛΛΑΓΩΝ ⇒
Section 8. Pharmacologic Approaches to Glycemic Treatment
New recommendations for antihyperglycemic therapy for adults with type 2 diabetes have been added to reflect recent cardiovascular outcomes trial (CVOT) data, indicating that people with atherosclerotic cardiovascular disease (ASCVD) should begin with lifestyle management and metformin and subsequently incorporate an agent proven to reduce major adverse cardiovascular events and/or cardiovascular mortality after considering drug-specific and patient factors.
The algorithm for antihyperglycemic treatment (Fig. 8.1) was updated to incorporate the new ASCVD recommendation.
A new table was added (Table 8.1) to summarize drug-specific and patient factors of antihyperglycemic agents. Figure 8.1 and Table 8.1 are meant to be used together to guide the choice of antihyperglycemic agents as part of patient–provider shared decision-making.
Table 8.2 was modified to focus on the pharmacology and mechanisms of available glucose-lowering medicines in the U.S.
A new recommendation was added that all hypertensive patients with diabetes should monitor their blood pressure at home to help identify masked or white coat hypertension, as well as to improve medication-taking behavior.
A new figure (Fig. 9.1) was added to illustrate the recommended antihypertensive treatment approach for adults with diabetes and hypertension.
A new table (Table 9.1) was added summarizing studies of intensive versus standard hypertension treatment strategies.
A recommendation was added to consider mineralocorticoid receptor antagonist therapy in patients with resistant hypertension.
The lipid management recommendations were modified to stratify risk based on two broad categories: those with documented ASCVD and those without.
Owing to studies suggesting similar benefits in older versus middle-aged adults, recommendations were consolidated for patients with diabetes 40–75 years and >75 years of age without ASCVD to use moderate-intensity statin.
Table 9.2 (“Recommendations for statin and combination treatment in adults with diabetes”) was updated based on the new risk stratification approach and consolidated age-groups.
To accommodate recent data on new classes of lipid-lowering medications, a recommendation was modified to provide additional guidance on adding nonstatin LDL-lowering therapies for patients with diabetes and ASCVD who have LDL cholesterol ≥70 mg/dL despite maximally tolerated statin dose.
The same recommendations were added here as in Section 8 that people with type 2 diabetes and ASCVD should begin with lifestyle management and metformin and subsequently incorporate an agent proven to reduce major adverse cardiovascular events and/or cardiovascular mortality after considering drug-specific and patient factors.
The text was substantially modified to describe CVOT data on new diabetes agents and outcomes in people with type 2 diabetes, providing support for the new ASCVD recommendations.
A new Table 9.4 was added to summarize the CVOT studies.
Section 10. Microvascular Complications and Foot Care
A new table was added (Table 10.1), replacing previous tables 10.1 and 10.2, that combines information on staging chronic kidney disease and the appropriate kidney-related care for each stage.
A new Table 10.2 was included describing the complications of chronic kidney disease and related medical and laboratory evaluations.
A new section on acute kidney injury was included.
The effect of specific glucose-lowering medications on the delay and progression of kidney disease was discussed, with reference to recent CVOT trials that examined kidney effects as secondary outcomes.
A new recommendation was added on the noninferiority of the anti–vascular endothelial growth factor treatment ranibizumab in reducing the risk of vision loss in patients with proliferative diabetic retinopathy when compared with the traditional standard treatment, panretinal laser photocoagulation therapy.
A new section was added describing the mixed evidence on the use of hyperbaric oxygen therapy in people with diabetic foot ulcers.
Σπύρος Καραμαγκιώλης – Διαβητολόγος
Αγρίνιο Λάρισα Διαβητικό Πόδι
Whelton PK, et al.
2017 High Blood Pressure Clinical Practice Guideline: Executive Summary
Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated
scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve
cardiovascular health. In 2013, the National Heart, Lung, and Blood Institute (NHLBI) Advisory Council
recommended that the NHLBI focus specifically on reviewing the highest-quality evidence and partner with
other organizations to develop recommendations (1, 2). Accordingly, the ACC and AHA collaborated with the
NHLBI and stakeholder and professional organizations to complete and publish 4 guidelines (on assessment
of cardiovascular risk, lifestyle modifications to reduce cardiovascular risk, management of blood cholesterol
in adults, and management of overweight and obesity in adults) to make them available to the widest possible
constituency. In 2014, the ACC and AHA, in partnership with several other professional societies, initiated a
guideline on the prevention, detection, evaluation, and management of high blood pressure (BP) in adults.
Under the management of the ACC/AHA Task Force, a Prevention Subcommittee was appointed to help guide
development of the suite of guidelines on prevention of cardiovascular disease (CVD). These guidelines, which
are based on systematic methods to evaluate and classify evidence, provide a cornerstone for quality
cardiovascular care. The ACC and AHA sponsor the development and publication of guidelines without
commercial support, and members of each organization volunteer their time to the writing and review efforts.
Guidelines are official policy of the ACC and AHA.
Το νέο Position Statement για τον Σακχ. Διαβήτη και την Αρτ. Υπέρταση της Αμερικανικής Διαβητολογικής Εταιρείας (ADA) »»
Hypertension is common among patients with diabetes, with the prevalence depending on type and duration of diabetes, age, sex, race/ethnicity, BMI, history of glycemic control, and the presence of kidney disease, among other factors. Furthermore, hypertension is a strong risk factor for atherosclerotic cardiovascular disease (ASCVD), heart failure, and microvascular complications. ASCVD—defined as acute coronary syndrome, myocardial infarction (MI), angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin—is the leading cause of morbidity and mortality for individuals with diabetes and is the largest contributor to the direct and indirect costs of diabetes. Numerous studies have shown that antihypertensive therapy reduces ASCVD events, heart failure, and microvascular complications in people with diabetes. Large benefits are seen when multiple risk factors are addressed simultaneously. There is evidence that ASCVD morbidity and mortality have decreased for people with diabetes since 1990 likely due in large part to improvements in blood pressure control. This Position Statement is intended to update the assessment and treatment of hypertension among people with diabetes, including advances in care since the American Diabetes Association (ADA) last published a Position Statement on this topic in 2003.
Ειδικός Παθολόγος – Διαβητολόγος
Εταιρεία Μελέτης Παθήσεων Διαβητικού Ποδιού (ΕΜΕΔΙΠ)
6ο Πανελλήνιο Συνέδριο για το Διαβητικό Πόδι και τις επιπλοκές του με Διεθνή Συμμετοχή
1 – 4 Φεβρουαρίου 2018, Αθήνα Ξενοδοχείο Crowne Plaza
επιστημονικό πρόγραμμα: σε αναμονή
Σχετικός σύνδεσμος: ΕΜΕΔΙΠ »»
Ειδικός Παθολόγος – Διαβητολόγος