Key Points in the ADA's New Diabetes Guidelines
The lipid treatment standards haven't changed. Patients should be treated to a low-density lipoprotein target level of < 100 mg/dL or < 70 mg/dL if they are high risk. In accordance with the new AHA guidelines, it is very important to consider every patient who has diabetes and who is older than age 40 years as somebody who likely will need to be put on statin therapy. The intensity of the statin therapy may vary on the basis of past cardiovascular events or risk for future cardiovascular events. Think hard about using statins in patients who are over the age of 40 with either type 1 or type 2 diabetes. There is less data about people with type 1 diabetes, but we know that they are at increased risk for cardiovascular disease, and in those individuals, we may need to individualize therapy more than in the population with type 2 diabetes. We still need to think about it in both groups and treat accordingly.
The hypertension treatment target is now a blood pressure of < 140/80 mm Hg in most patients with diabetes, although a lower target may be recommended in younger patients. It is not recommended to use angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for the prevention of nephropathy in patients who do not have elevated blood pressure levels.
That is an outline of the 2014 ADA Standards of Care. I encourage you to read through them. The full report is available online, as well as an executive summary and a summary of revisions from previous standards if you want the short version. Hopefully you will review them and continue to treat your patients with type 2 diabetes to their own individualized targets. This has been Dr. Anne Peters for Medscape.
Managing Cardiovascular Risk in Diabetes
The lipid treatment standards haven't changed. Patients should be treated to a low-density lipoprotein target level of < 100 mg/dL or < 70 mg/dL if they are high risk. In accordance with the new AHA guidelines, it is very important to consider every patient who has diabetes and who is older than age 40 years as somebody who likely will need to be put on statin therapy. The intensity of the statin therapy may vary on the basis of past cardiovascular events or risk for future cardiovascular events. Think hard about using statins in patients who are over the age of 40 with either type 1 or type 2 diabetes. There is less data about people with type 1 diabetes, but we know that they are at increased risk for cardiovascular disease, and in those individuals, we may need to individualize therapy more than in the population with type 2 diabetes. We still need to think about it in both groups and treat accordingly.
The hypertension treatment target is now a blood pressure of < 140/80 mm Hg in most patients with diabetes, although a lower target may be recommended in younger patients. It is not recommended to use angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for the prevention of nephropathy in patients who do not have elevated blood pressure levels.
That is an outline of the 2014 ADA Standards of Care. I encourage you to read through them. The full report is available online, as well as an executive summary and a summary of revisions from previous standards if you want the short version. Hopefully you will review them and continue to treat your patients with type 2 diabetes to their own individualized targets. This has been Dr. Anne Peters for Medscape.
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