New guidelines for treating diabetes

Every year, the American Diabetes Association (ADA) issues Clinical Practice Recommendations, a series of updated recommendations to help health care providers treat people with diabetes using the most current research available.

This year's recommendations, to a greater extent than those published in previous years, provide a more comprehensive review of ADA's "Standards of Medical Care in Diabetes," which contain all of ADA's key recommendations. In addition, the Clinical Practice Recommendations include current position statements on certain topics not adequately covered in the "Standards."

More than 18 million Americans are currently living with diabetes -- a chronic disease that affects the body's ability to produce or respond to insulin and can lead to life-threatening illness including heart disease and stroke, blindness, kidney disease and nerve disease resulting in amputation.

"The Clinical Practice Recommendations, which are updated annually, can serve as an incredible resource for health care professionals by giving them the most up-to-date medical information available," said Nathaniel Clark, MD, RD, National Vice President of Clinical Affairs for the American Diabetes Association. "New research is published almost daily. What we do is constantly review all of that research so that we can provide these increasingly busy practitioners with information about the most effective treatment options for people with diabetes."

The updated 2005 Clinical Practice Recommendations, which can be downloaded to a Palm OS Device, include additions to the "Standards" related to screening for diabetes, prevention of type 2 diabetes, psychosocial assessment and care for people with diabetes, an expanded section on diabetes care in specific populations including children and adolescents with type 1 diabetes, and diabetes in specific settings such as hospitals, schools and day care centers, camps and correctional institutions.

People with diabetes are two-to-four times more likely than others to develop heart disease and are more likely to die from heart attacks than people who don't have diabetes. Based on recent studies including the Collaborative Atorvastatin Diabetes Study (CARDS), revisions to the "Standards of Medical Care for Diabetes" include recommendations on lipid management for people with diabetes with or without overt cardiovascular disease. The ADA guidelines recommend the use of statins for people with diabetes over the age of 40 who have a total cholesterol level that is greater than or equal to 135 mg/dl. The primary goal continues to be an LDL<100 mg/dl. People with diabetes and overt cardiovascular disease, who are at very high risk for further events, should be treated using a high dose of a statin, and, in these high risk patients, a lower LDL cholesterol goal of <70mg/dl, is an option.

Other revisions include an expanded review of Medical Nutrition Therapy to examine more fully the role of carbohydrates in the diet of those with diabetes and the role of lifestyle modification in obesity prevention and management.

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