Funded out Association’s general revenues and does not use industry support. Funded out Association’s general revenues and does not use industry support

Use of point-of-care (POC) testing for A1C provides the opportunity for more timely treatment changes. E

A reasonable A1C goal for many nonpregnant adults is <7% (53 mmol/mol). A

• A reasonable A1C goal for many nonpregnant adults is <7% (53 mmol/mol). A

• Consider more stringent goals (e.g. <6.5%) for select patients if achievable without significant hypos or other adverse effects. C

• Consider less stringent goals (e.g. <8%) for patients with a history of severe hypoglycemia, limited life expectancy, or other conditions that make <7% difficult to attain. B

DCCT: Trend toward lower risk of CVD events with intensive control (T1D)

• DCCT: Trend toward lower risk of CVD events with intensive control (T1D)

• EDIC: 57% reduction in risk of nonfatal MI, stroke, or CVD death (T1D)

• UKPDS: nonsignificant reduction in CVD events (T2D).

• ACCORD, ADVANCE, VADT suggested no significant reduction in CVD outcomes with intensive glycemic control. (T2D)

More or less stringent glycemic goals may be appropriate for individual patients.

• More or less stringent glycemic goals may be appropriate for individual patients.

• Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goals.

Individuals at risk for hypoglycemia should be asked about symptomatic and asymptomatic hypoglycemia at each encounter. C

• Individuals at risk for hypoglycemia should be asked about symptomatic and asymptomatic hypoglycemia at each encounter. C

• Glucose (15–20 g) preferred treatment for conscious individual with blood glucose < 70 mg/dL. E

• Glucagon should be prescribed for those at increased risk of clinically significant hypoglycemia, defined as blood glucose < 54 mg/dL, so it is available if needed. E

• Hypoglycemia unawareness or episodes of severe hypoglycemia should trigger treatment re-evaluation. E

Insulin-treated patients with hypoglycemia unawareness or an episode of severe hypoglycemia should be advised to raise glycemic targets to strictly avoid further hypoglycemia for at least several weeks, to partially reverse hypoglycemia unawareness, and to reduce risk of future episodes. A

• Insulin-treated patients with hypoglycemia unawareness or an episode of severe hypoglycemia should be advised to raise glycemic targets to strictly avoid further hypoglycemia for at least several weeks, to partially reverse hypoglycemia unawareness, and to reduce risk of future episodes. A

• Ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia by the clinician, patient, and caregivers if low cognition and/or declining cognition is found. B

Delay progression from prediabetes to type 2 diabetes

• Delay progression from prediabetes to type 2 diabetes

• Positive impact on treatment of type 2 diabetes

• Most likely to occur early in disease development

• Improves mobility, physical and sexual functioning & health-related quality of life

At each patient encounter, BMI should be calculated and documented in the medical record. B

• At each patient encounter, BMI should be calculated and documented in the medical record. B

• Discuss with the patient
• Asian American cutpoints:

Diet, physical activity & behavioral therapy designed to achieve >5% weight loss should be prescribed for overweight & obese patients with T2DM ready to achieve weight loss. A

• Diet, physical activity & behavioral therapy designed to achieve >5% weight loss should be prescribed for overweight & obese patients with T2DM ready to achieve weight loss. A

• Interventions should be high-intensity (≥16 sessions in 6 months) and focus on diet, physical activity & behavioral strategies to achieve a 500 - 750 kcal/day energy deficit. A

Diets should be individualized, as those that provide the same caloric restriction but differ in protein, carbohydrate, and fat content are equally effective in achieving weight loss. A

• Diets should be individualized, as those that provide the same caloric restriction but differ in protein, carbohydrate, and fat content are equally effective in achieving weight loss. A

• Patients who achieve short-term weight loss goals should be prescribed long-term maintenance programs. A

Short-term (3-month) interventions that employ very low calorie diets (<800 kcal/day) and total meal replacements may be prescribed for select patients by trained practitioners with close medical monitoring. To maintain weight loss, such programs must incorporate long-term, comprehensive, weight maintenance counseling. B

• Short-term (3-month) interventions that employ very low calorie diets (<800 kcal/day) and total meal replacements may be prescribed for select patients by trained practitioners with close medical monitoring. To maintain weight loss, such programs must incorporate long-term, comprehensive, weight maintenance counseling. B