實戰課題Medical internship topic 4: Diabetes mellitus ADA guideline

Diabetes mellitus ADA guideline(2016)

1. DM types: type 1, type 2, GDM, MODY
2. Diagnosis

Diabetes Care Volume 39, Supplement 1, January 2016

3. Evaluation/Prevention

-- To test for prediabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate.

-- For all patients, testing should begin at age 45 years. (repeat every 3 years)

4. Management for type 1 DM

-- Multiple-dose insulin injections (three to four injections per day of basal and prandial insulin) or CSII therapy(Continuous Subcutaneous Insulin Infusion)

5. Management for type 2 DM

-- first line: Metformin

-- insulin use: if newly diagnosed and markedly symptomatic and/or elevated blood glucose levels or A1C

-- add therapy if: goal failed after 3 months

6.  Drugs

Diabetes Care Volume 39, Supplement 1, January 2016

Diabetes Care Volume 39, Supplement 1, January 2016

Diabetes Care Volume 39, Supplement 1, January 2016

7. Mixed therapy

-- Noninsulin agents may be continued, although sulfonylureas, DPP-4 inhibitors, and GLP-1 receptor agonists are typically stopped once more complex insulin regimens beyond basal are used

-- Regular human insulin and human NPH-Regular premixed formulations (70/30) are less costly alternatives to rapid-acting insulin analogs and premixed insulin analogs, respectively, but their pharmacodynamic profiles make them suboptimal to cover postprandial glucose excursions