The American diabetes association guidelines
Diabetes is one of the chronic complex diseases which entail a constant medical care, hence The American Diabetes Association (ADA) issues an annual report on the standards of care to highlight the progress achieved in the area of diabetes treatment, based on empirical research on the diagnosis and treatment of children and adults with type 1 diabetes, type 2 diabetes, or gestational diabetes.ADA’s report comes as a result of the joint efforts of 15 U.S diabetes experts namely, physicians, certified dietitians, public health specialists…etc.An online version of the standards of medical care known as the Living Standards of Care undergoes a constant update process and can be reached from here.
So what are the basic concepts of ADA’s standards of medical care in diabetes for 2019?
It is remarkable to note That the recommendations of the American Diabetes Association this year 2019, implied a paradigm change as far as the patient-doctor relation is concerned as it laid stress on the significance of raising the awareness of the patient and his family of his condition, along with establishing a dialogue between the patient and his attending physician.
- Maintaining the heart health:
Cardiovascular diseases are considered one of the factors which contributes to the death of people with diabetes. People with type 2 diabetes are twice as likely to die of heart disease as people without diabetes as stated by the Centers for Disease Control and Prevention (CDC). Furthermore, a close cooperation between the American Diabetes Association (ADA) and the American College of Cardiology to verify compliance between ADA’s recommendations and the heart health standards, in order to reduce the mortality rate of diabetic patients due to cardiovascular diseases .“We are in a partnership with American Heart Association to educate the patient on cardiovascular disease,” Cefalu says. “We want the patient to be educated and discuss this with their physicians.”
Tips for people with diabetes on how to protect their hearts according to the American Heart Association:
- Follow a healthy diet, replace foods high in saturated fat, trans fat, salt, and cholesterol with food which is rich in fibers. Following a healthy diet will not only protect your heart but will also help with your diabetes.
- Exercise aerobics or indulge in light activities for a minimum of half an hour, five times per week
- Adhere to the instructions of the attending physician concerning medications dose, taking medicines on time…etc
- Keep fit, try to lose any extra weight, this will help reduce both your blood pressure and your blood sugar levels.
- Stop smoking, smoking represents a great risk for diabetic patients, heart patients, or those who suffer from both diseases together, you may seek your doctor’s help.
- Consume a daily low dose of aspirin after consulting your doctor
- Maintain blood cholesterol levels within the desired limit i.e.below 100 for LDL cholesterol and above 40 for HDL cholesterol
- Maintain blood pressure within the normal range i.e 120/80
- Keep blood glucose level within the designed range by undergoing A1C tests every six month; A normal A1C level should be below 5.7.
- Each patient is a unique battlefield :
since ADA’s new guidelines emphasized that the treatment protocol has to be patient-oriented. The updated version of ADA’s guidelines included a special section dedicated to nutrition and physical activity of the elderly people over the age of 65, as well as, directions for youth and kids who suffer from type 2 diabetes in terms of diabetes diagnosis, treatment, weight loss, lifestyle…etc
The type of medical care provided for youth and kids varies according to diabetes type. Furthermore, the standards of medical care in diabetes observe the transition of a diabetic patient from childhood into adulthood
What is the difference between diabetes type 1 and diabetes type 2 in terms of medical care?
Although this type is usually associated with adults, caregivers have to consider the transition from childhood into adulthood of the diabetic patient, as regards the following:
- Neurological vulnerability to hypoglycemia and hyperglycemia in young children,
- Possible unfavorable neurocognitive effects of diabetic ketoacidosis
- Insulin sensitivity due to physical growth and sexual maturity
- Attending to the child at the daycare centers /schools
- The child’s capacity to attend to his personal care duties
ADA’s guidelines for youth and kids with type 1 diabetes:
Controlling cardiovascular risk factors: A diabetic patient must be very cautious with the factors that are likely to affect his heart health such as smoking, hypertension, and dyslipidemia
What are the possible microvascular complications for children with diabetes?
❖ Neuropathy: A child with diabetes has to undergo a comprehensive foot examination every year starting from the age of 10 (beginning of puberty) provided that he had been diagnosed with type 1 diabetes for 5 years
❖ Retinopathy: Retinopathy usually occurs at the start of puberty or ( 5-10 years of diabetes diagnosis). Thus, a child – who is at least 10 years old and diagnosed with type 1 diabetes for 3-5 years, should have a comprehensive initial eye examination. This procedure should be repeated annually or as the ophthalmologist may recommend
❖ Nephropathy: Diabetic children at the age of 10 or older have to undergo an annual albuminuria test, five years after diabetic diagnosis to minimize the chances of diabetic kidney diseases
❖ Diabetes self- awareness, management and Support: Raising the awareness of the diabetic child, family and care provider, represents an important factor in the treatment process, especially if the child is below the age of 18. Diabetes self- awareness, management, and Support involve regular re-evaluation, particularly during the stage where the child grows and requires more independent self-care skills. It is also important to re-evaluate the skills and level of awareness of those who attend to the diabetic young children at schools or daycare centers.
❖ Nutrition Therapy: Following a dietary system tailored to the needs and condition of the individual diabetic patient is part and parcel of the treatment process. The patient diet should consider the child’s food preference, physical activity, family traditions…etc
ADA recommends that youth and children with diabetes type 1. should observe their carbohydrate consumption to control glucose levels in their blood. They should also have regular assessment of their weight status, factors which may cause cardiovascular risks, food preference, and eating disorders if any.
❖ Exercise and Physical Activity: Youth and children with type1 diabetes are advised to exercise for 60 minutes daily, which may range from moderate to strong physical activity provided that the different glycemia patterns are considered during and after exercise.
Physical exercise is particularly important for controlling weight, controlling insulin sensitivity, enhancing self-esteem and social interaction, as well as helping diabetic children and youth develop healthy habits
❖ Glycemic Control: Most children /youth with diabetes type1 receive high doses of insulin during the course of treatment. They have to be able to check their glucose levels on their own several times a day. In addition to self- monitoring, the use of new techniques including, rapid and long-acting insulin analogs and automated insulin delivery systems helps in avoiding the unfavorable influences associated with diabetes type1 on the brain development and function
❖ Schools and Daycare Centers: Since children spend a great part of the day at schools/daycare centers, their attendants are essentially involved in the treatment process hence they should receive proper education on diabetes
❖ Psychological concerns: Childhood all through to adulthood represents a stage that is characterized by rapid and intensely emotional, intellectual, and developmental changes which requires great care when managing diabetes, as well as, constant psychological assessment of the diabetic patient, such assessment may be conducted as early as at the age of 7 or 8. Eating disorders are likely to occur at the age of 10-12. It is worth mentioning here that early detection of eating disorders, learning difficulties, or depression, can help reduce the negative effects of diabetes
❖ Autoimmune Conditions: Due to the increase of autoimmune diseases that affect patients with type1 diabetes, screening for thyroid dysfunction and celiac disease has to be conducted immediately after detection.
❖ Thyroid Disease: Autoimmune thyroid is the most common autoimmune disease accompanying diabetes. Once the child is diagnosed with type 1 diabetes he has to undergo an antithyroid peroxidase and antithyroglobulin antibodies.
❖ Celiac Disease: It is an immune-mediated disease that mostly affects people with type 1 diabetes. A child should be tested for celiac disease right after he is being diagnosed with diabetes, this test has to be repeated twice after that, once after 2 years from the initial test while the other after 5 years. In case the child was diagnosed with Celiac, he has to follow a gluten-free diet
ADA’s guidelines for youth and kids with type 2 diabetes:
The past 20 years have witnessed a notable increase in the number of youth affected by type 2 diabetes, this number is expected to increase four-fold within the coming 40 years. Type 2 diabetes is especially characterized by the rapid development of diabetes complications and accelerated decline of β-cell function
Similarly to the children with diabetes type 1, children affected by diabetes type 2 spend a great part of the day at schools, hence, school staff is involved in the process of diabetes management
screening: prediabetes and type 2 diabetes are usually associated with obesity, thus obese children over the age of 10, must be examined for diabetes