TY - JOUR
T1 - American Association of Clinical Endocrinology Clinical Practice Guideline
T2 - Developing a Diabetes Mellitus Comprehensive Care Plan—2022 Update
AU - Blonde, Lawrence
AU - Umpierrez, Guillermo E.
AU - Reddy, S. Sethu
AU - McGill, Janet B.
AU - Berga, Sarah L.
AU - Bush, Michael
AU - Chandrasekaran, Suchitra
AU - DeFronzo, Ralph A.
AU - Einhorn, Daniel
AU - Galindo, Rodolfo J.
AU - Gardner, Thomas W.
AU - Garg, Rajesh
AU - Garvey, W. Timothy
AU - Hirsch, Irl B.
AU - Hurley, Daniel L.
AU - Izuora, Kenneth
AU - Kosiborod, Mikhail
AU - Olson, Darin
AU - Patel, Shailendra B.
AU - Pop-Busui, Rodica
AU - Sadhu, Archana R.
AU - Samson, Susan L.
AU - Stec, Carla
AU - Tamborlane, William V.
AU - Tuttle, Katherine R.
AU - Twining, Christine
AU - Vella, Adrian
AU - Vellanki, Priyathama
AU - Weber, Sandra L.
N1 - Funding Information:
consultant: Boehringer Ingelheim, Eli Lilly and Company, Sanofi, Weight Watchers; research support to Emory University for investigator-initiated studies and national or overall principal investigator: Dexcom, Eli Lilly and Company, Novo Nordisk; partially supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) under Award Numbers P30DK111024, K23DK123384
Funding Information:
Accurate measurement of BP is fundamental to diagnosis and effective management of hypertension.210,211,228 The equipment, which can be aneroid, mercury, or electronic, should be inspected and validated on a regular maintenance schedule. Initial training and regularly scheduled retraining in the standardized technique for BP measurement provides consistency and reliability of BP readings. Individuals must be properly prepared and positioned to obtain an accurate BP; serial BP readings are recommended to be measured after being seated quietly for at least 5 minutes in a chair (rather than on an exam table) with feet on the floor and arm supported at heart level. Caffeine, exercise, and smoking should be avoided for at least 30 minutes prior to measurement. Measurement of BP in the standing position is also indicated in persons suspected to have postural hypotension. An appropriately sized cuff (ie, cuff bladder encircling at least 80% of the arm) should be used to ensure accuracy. At least 2, and preferably 3, serial measurements should be obtained, and the average BP recorded.For ICU settings, most hospitals use institutional-based, nurse-driven protocols, with several validated protocols published. 1291-1293 Automated, computerized, IV insulin protocols, including commercially available or institutional-based protocols, have improved glycemic control, with good acceptance by nursing personnel. 1294-1307 The preference will depend on local needs, support, and cost to the institution. Preference should be given to use of regular insulin for IV administration,1308,1309 given lower cost and wide availability, and short-acting insulin analogs have shown effective glycemic control.1308
Funding Information:
This CPG on developing a comprehensive plan for the care of persons with diabetes mellitus was developed with financial support from the American Association of Clinical Endocrinology (AACE). All members who served on this AACE task force completed work on the manuscript electronically and met via video conferences. AACE received no outside funding for the development of this guideline. Volunteer authors on this task force received no remuneration for their participation in development of this guideline.
Publisher Copyright:
© 2022 AACE
PY - 2022/10
Y1 - 2022/10
N2 - Objective: The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. Methods: The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. Results: This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. Conclusions: This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
AB - Objective: The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. Methods: The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. Results: This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. Conclusions: This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
KW - antihyperglycemic medications
KW - atherosclerotic cardiovascular disease
KW - cardiovascular diseases
KW - diabetes
KW - diabetes mellitus
KW - diabetes mellitus, type 1
KW - diabetes mellitus, type 2
KW - diabetic nephropathies
KW - diabetic neuropathies
KW - diabetic retinopathy
KW - dyslipidemias
KW - gestational
KW - guideline
KW - hospitalization
KW - hypertension
KW - hypoglycemia
KW - infertility
KW - interdisciplinary communication
KW - metabolic syndrome
KW - obesity
KW - occupations
KW - prediabetic state
KW - pregnancy
KW - secondary diabetes
KW - sleep apnea syndromes
KW - telemedicine
KW - vaccination
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U2 - 10.1016/j.eprac.2022.08.002
DO - 10.1016/j.eprac.2022.08.002
M3 - Article
C2 - 35963508
AN - SCOPUS:85139279760
SN - 1530-891X
VL - 28
SP - 923
EP - 1049
JO - Endocrine Practice
JF - Endocrine Practice
IS - 10
ER -