CHANGES in ada 2015

The physical activity was revised to reflect evidence that all individuals, including those with diabetes , should be encouraged to limit the amount of time they spend being sedentary by breaking up extended amount s of time (.90 min) spent sitting The BMI cut point for screening overweight or obese Asian Americans for pre diabetes and type2 diabetes was changed to 23 kg/m2 (vs. 25 kg/m2) to reflect the evidence that this population is at an increased risk for diabetes at lower BMI levels relative to the general population.

The ADA now recommends a premeal blood glucose target of 80–130 mg/dL, rather than 70–130 mg/dL, to better reflect new data comparing actual average glucose levels with A1C targets goal for diastolic blood pressure was changed from 80 mmHg to 90 mmHg for most people with diabetes the Standards emphasize that all patients with insensate feet, foot deformities, or a history of foot ulcers have their feet examined at every visit. the Standards now recommend a target A1C of ,7.5% for all pediatric age- groups;however,individualizationis still encouraged

CHANGES in ADA 2016

American Diabetes Association’s (ADA ’s) position that diabetes does not define people , the word “diabetic discussion of diagnostic tests (fasting plasma glucose, 2-h plasma glucoseaftera75-goralglucosetolerance test, and A1C criteria) were revised to make it clear that no one test is preferred over another for diagnosis test all adults beginning at age 45 years, regardless of weight. Testing is also recommended for asymptomatic adults of any age who are overweight or obese and who have one or more additional risk factors for diabetes. People who use continuous glucose monitoring and insulin pumps should have continued access after they turn 65 years of age

“Atherosclerotic cardiovascular disease” (ASCVD) has replaced the former term “cardiovascular disease” (CVD), as ASCVD is a more specific term to consider aspirin therapy in women aged .60 years has been changed to include women aged 50 years. A recommendation was also added to address antiplatelet use in patients aged ,50 years with multiple risk factors. “Nephropathy” was changed to “diabetic kidney disease” to emphasize that, while nephropathy may stem from a variety of causes, attention is placed on kidney disease that is directly related to diabetes.

A fasting lipid profile in children starting at age 2 years has been changed to age 10years,based on a scientific statement on type 1 diabetes and cardiovascular disease from the American Heart Association and the ADA A1C recommendations for pregnant women with diabetes were changed, from a recommendation of ,6% (42 mmol/mol) to a target of 6–6.5%

—Screening for and diagnosis of GDM One-step strategy Perform a 75-g OGTT, with plasma glucose measurement when patient is fasting and at 1 and 2 h, at 24 –28 weeks of gestation in women not previously diagnosed with overt diabetes. The OGTT should be performed in the morning after an overnight fast of at least 8 h. Fasting: 92 mg/dL (5.1 mmol/L) c 1 h: 180 mg/dL (10.0 mmol/L) c 2 h: 153 mg/dL (8.5 mmol/L)

Two-step strategy Step 1: Perform a 50-g GLT (non fasting), with plasma glucose measurement at 1 h, at 24–28 weeks of gestation in women not previously diagnosed with overt diabetes. If the plasma glucose level measured 1 hafter the load is 140 mg/dL*(7.8mmol/L),proceed to a 100-g OGTT. Step 2: The 100-g OGTT should be performed when the patient is fasting. The diagnosis of GDM is made if at least two of the following four plasma glucose levels (measured fasting and 1 h, 2 h, 3 h after the OGTT) are met or exceeded: c Fasting 95 mg/dL \ 1 h 180 mg/dL (10.0 mmol/L) 190 mg/dL (10.6 mmol/L) c 2 h 155 mg/dL (8.6 mmol/L) 165 mg/dL (9.2 mmol/L) c 3 h 140 mg/dL (7.8 mmol/L) 145 mg/dL (8.0 mmol/L) NDDG, National Diabetes Data Group.*The ACOG recommends a lower threshold of 135 mg/dL (7.5 mmol/L) in high-risk ethnic populations with higher prevalence of GDM; some experts also recommend 130 mg/dL (7.2 mmol/L).

General Principles for Management of Diabetes in Pregnancy Lifestyle change is an essential component of management of gestational diabetes mellitus and may suffice for treatment for many women. Medications should be added if needed to achieve glycemic targets. Prefered medications in gestational diabetes mellitus are insulin and metformin; glyburide may be used but may have a high rate of neonatal hypoglycemia and macrosomia than insulin or metformin. Other agents have not been adequately studied.

Potentially teratogenic medications (ACE inhibitors, statins, etc.) Fasting, preprandial, and postprandial self-monitoring of blood glucose are recommended in both gestational diabetes mellitus and pregestational diabetes in pregnancy to achieve glycemic control. Due to increased red blood cell turn over, A1C is lower in normal pregnancy than in normal non pregnant women. The A1C target in pregnancy is 6–6.5% (42–48mmol/mol);,6%(42mmol/mol)may be optimal if this can be achieved without significant hypoglycemia, but the target may be relaxed to ,7% (53 mmol/mol) if necessary to prevent hypoglycemia.

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