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Diabetes Management Guidelines

American Diabetes Association (ADA) 2016 Guidelines

 
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Source: American Diabetes Association. Standards of medical care in diabetes—2016.
Diabetes Care. 2016;39(suppl 1):S1-S106. Available here.

Refer to source document for full recommendations, including class of recommendation and level of evidence.
  

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Screening & Diagnosis
Glycemic Targets
Type 2 Diabetes Prevention
Type 2 Diabetes Pharmacologic Therapy
Type 1 Diabetes Pharmacologic Therapy
Insulin & Glucose Monitoring
Lifestyle Changes
Obesity & Bariatric Surgery
Cardiovascular Disease  
Diabetes Complications
Pregnancy/Gestational Diabetes
In-Patient Glycemia
Older Adults
Children & Adolescents
Psychosocial Care
Immunizations
HIV
Cystic Fibrosis
 

 In-Patient Glycemia  

 Diabetes Care in the Hospital 

Insulin is preferred method for glycemic control in the hospital setting

  • Exclusive use of SSI is strongly discouraged
 

Recommendations for diabetes care of patients in the ICU (critical care):

  • Intravenous insulin shown to be the best method for achieving glycemic targets
  • Administer using validated written or computerized protocols that allow for predefined adjustments in infusion rate based on glycemic fluctuations and insulin dose
 

Recommendations for diabetes care of patients in noncritical care settings:

  • Scheduled subcutaneous insulin injections that align with meals and bedtime*
  • Insulin regimen with basal, nutritional, and correction components (basal-bolus) for individuals with good nutritional intake
  • Basal plus correction insulin regimen for individuals with poor oral intake or who are NPO
 
The safety and efficacy of noninsulin therapies are being studied
*Or every 4-6 hrs if no meals or if continuous enteral/parenteral therapy being used
 Glycemic Targets for Critically Ill Individuals 
Insulin is the preferred method for achieving glycemic control for diabetes care in the hospital

Recommendations for critically ill individuals with persistent hyperglycemia:

  • Initiate insulin starting at ≤180 mg/dL (10.0 mmol/L)
  • Once insulin is started, a target glucose range of 140-180 mg/dL (7.8-10.0 mmol/L) is recommended for most patients
 

More stringent targets may be appropriate for certain patients providing a lower target does not confer increased hypoglycemia risk

  • 110-140 mg/dL (6.1-7.8 mmol/L)
 

A hypoglycemia management protocol should be established for each patient:

  • A plan for prevention and treatment of hypoglycemia should be developed
  • All episodes of hypoglycemia should be documented and tracked
  • The treatment plan should be reviewed and changed when glucose is <70 mg/dL (3.9 mmol/L)
 
 Glycemic Targets for Noncritically Ill Individuals 
  • Glucose target of 140-180 mg/dL (7.8-10.0 mmol/L) is recommended for most
  • A lower target (<140 mg/dL) may be appropriate for individuals with a prior history of successful tight glycemic control and who are clinically stable
  • Higher ranges may be appropriate for individuals who are terminally ill, have severe comorbidities, or are in in-patient care settings where frequent glucose monitoring is not feasible
 
 Recommendations for Perioperative Care 

Target glucose range for perioperative period:

  • 80-180 mg/dL (4.4-10.0 mmol/L)
 
Perioperative risk assessment for individuals at high risk for ischemic heart disease and those with autonomic neuropathy or renal failure
On the morning of the procedure, withhold OADs and give half of the NPH dose or full doses of long-acting analog or pump basal insulin
Monitor blood glucose every 4-6 hours while NPO and dose with short-acting insulin as needed
 
Click slides to view larger.
All slides available for download in the Slide Library.
 
ADA 2016 Diabetes Care in the Hospital  ADA 2016 Glycemic Targets for Critically Ill Individuals 
   
ADA 2016 Glycemic Targets for Non-Critically Ill Individuals   ADA 2016 Perioperative Care 
Back Pregnancy/Gestational Diabetes  Next Older Adults 

NPH=neutral protamine hagedorn; NPO=nothing by mouth; OADs=oral antidiabetes drugs; SSI=sliding scale insulin

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA) unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States. 

January 2016 

This content was created by Ashfield Healthcare Communications, and was not associated with funding via an educational grant or a promotional/commercial interest.  

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