ada diabetes guidelines 2020
Insulin should be added if needed to achieve glycemic targets. E, 10.18 Obtain a lipid profile at initiation of statins or other lipid-lowering therapy, 4–12 weeks after initiation or a change in dose, and annually thereafter as it may help to monitor the response to therapy and inform medication adherence. The 2020 Standards of Medical Care in Diabetes includes all of ADA's current clinical practice recommendations and is intended to provide clinicians, patients, researchers, payers, and others with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Adapted from Battelino T, Danne T, Bergenstal RM, et al. C, Hyperglycemia in hospitalized patients is defined as blood glucose levels >140 mg/dL (7.8 mmol/L). The new revisions include changes for screening, nutrition and assessing blood glucose management and more. Approximately one-quarter of people over the age of 65 years have diabetes and one-half of older adults have prediabetes. B, 11.7 In nonpregnant patients with diabetes and hypertension, either an ACE inhibitor or an ARB is recommended for those with modestly elevated UACR (30–299 mg/g Cr) B and is strongly recommended for those with UACR ≥300 mg/g Cr and/or eGFR <60 mL/min/1.73 m2. See “15. C, 10.4 For individuals with diabetes and hypertension at higher CV risk (existing ASCVD or 10-year ASCVD risk ≥15%), a blood pressure target of <130/80 mmHg may be appropriate, if it can be safely attained. C, 12.7 Screening for diabetes complications should be individualized in older adults. B, 2.10 If tests are normal, repeat testing carried out at a minimum of 3-year intervals is reasonable. If any level of diabetic retinopathy is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist. B, 10.14 Patients with hypertension who are not meeting blood pressure targets on three classes of antihypertensive medications (including a diuretic) should be considered for mineralocorticoid receptor antagonist therapy. If oral medications are held in the hospital, there should be a protocol for resuming them 1–2 days before discharge. 10.38 In asymptomatic patients, routine screening for coronary artery disease is not recommended as it does not improve outcomes as long as ASCVD risk factors are treated. Adapted from de Boer IH, Bangalore S, Benetos A, et al. Diabetes Care 2018;41:2669–2701. A For patients on dialysis, higher levels of dietary protein intake should be considered, since malnutrition is a major problem in some dialysis patients.

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