AACE publishes comprehensive diabetes management algorithm to treat prediabetes, T2DM patients

The American Association of Clinical Endocrinologists (AACE) today announced the publication of its comprehensive diabetes management algorithm created to guide primary care physicians, endocrinologists and other health care professionals in the treatment of prediabetes and type 2 diabetes mellitus (T2DM) patients.

“We have expanded on our previous efforts to address broad-reaching, critical factors that accompany the disease and its treatment.”

Recommendations in the algorithm, published online at https://www.aace.com/files/glycemic-control-algorithm.pdf and in the March/April 2013 issue of the association's peer-reviewed scientific journal Endocrine Practice, consider the whole patient, the spectrum of risks and complications for the patient, and evidence-based approaches to treatment.

Specifically, the document provides suggestions for treatment prioritization and risk-reduction strategies while addressing the following circumstances and conditions that frequently are precursors to, or are concurrent with, a T2DM diagnosis:

• Management of diabetes and co-existing diseases or disorders in the prediabetic phase of disease.
• A hierarchy of steps for the management of high blood sugar control using an approach that balances age and comorbidities while minimizing the adverse effects of hypoglycemia and weight gain.
• Complications-centric treatment of the overweight or obese patient, as opposed to a body mass index (BMI)-centric approach, including medical and surgical treatments for greater weight loss.
• Management of cardiovascular disease risk factors, hypertension and hyperlipidemia (high lipid levels) in those patients with prediabetes or T2DM.

Among the algorithm's key recommendations is that a comprehensive care plan for persons with diabetes must now consider obesity management as an integral part of the overall treatment plan to effectively reduce morbidity, mortality and disability in the majority of patients with T2DM who are obese.

Also, while suggesting an blood sugar goal of <6.5% as optimal for most diabetes patients if it can be achieved in a safe manner, the algorithm recommends the target be individualized based on numerous factors such as age, comorbid conditions, duration of diabetes, risk of hypoglycemia, patient motivation and adherence, and life expectancy. Higher targets may be appropriate for some individuals and may change for a given individual over time.

The algorithm includes every FDA-approved class of medications for diabetes and differentiates the choice of therapies based on the patient's initial A1C.

"This algorithm is a definitive, point-of-care tool for clinicians engaged in the treatment of those who are at risk for or have developed diabetes," said Alan Garber, MD, PhD, FACE, chair of the algorithm task force and President of AACE. "We have expanded on our previous efforts to address broad-reaching, critical factors that accompany the disease and its treatment."

"With more than 100 million suffering from diabetes and prediabetes in the United States, there simply are not enough endocrinologists to care for all patients," he added. "Thus, this algorithm is essential to assist and educate clinicians who are charged with these patients' care."