New AACE/ACE Diabetes Guidelines Go Beyond Glycemic Control

The new AACE clinical practice guidelines for diabetes and updated diabetes algorithm advocate a comprehensive approach to managing diabetes.

Creating a comprehensive care plan for diabetes that focuses on more than just glycemic control is at the heart of the new clinical practice guidelines for diabetes from the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE).

On April 9, 2015, AACE/ACE announced the publication of the guidelines as well as an updated diabetes algorithm to assist clinicians with the medical management of patients with diabetes mellitus (DM).

The 2015 guidelines advocates for comprehensive control of diabetes by addressing multiple DM risk factors.1

“The major principles of the 2011 DM guidelines, namely a comprehensive approach to the managing of DM, are continued in the 2015,” said chair of the guidelines task force Yehuda Handelsman, MD, who is the medical director and principal investigator of the Metabolic Institute of America in Tarzana, California. 

“In 2015, the guidelines have expanded greatly. We are now posting 24 questions and a total of 67 (answers) recommendations. We have also added several new chapters on vaccinations, relationship to cancer and special populations, among others. Many sections were expanded, including screening, sleep apnea, depression and medical management.”

Addressing All Aspects of Diabetes

Handelsman, who is also president of ACE, said comprehensive clinical recommendations are offered for assessing and managing obesity, lipid disorders, hypertension, kidney disease, cardiovascular disease (CVD), hypoglycemia and antihyperglycemic therapy to prevent complications. Many of the new recommendations involve substantial modifications over previous guidelines due to so many newly approved agents, he noted.

“The guidelines are evidence-based and cover all parts of DM from classification through diagnosis, screening management, assessing complications, defining goals and preventing complications. Though written very comprehensively, it is in a manner which is easy to navigate,” Handelsman said.

“The algorithm, though also evidence-based, primarily represents a consensus of experts and focuses just on the management aspect. It is kind of a cookbook to managing diabetes.”

Both the guidelines and algorithm have been constructed to address specific problems in diabetes care in a concise, practical and actionable manner, according to Handelsman.

For instance, the guidelines state that patients with DM should engage in at least 150 minutes per week of moderate-intensity exercise, such as brisk walking (a 15- to 20-minute mile) or its equivalent. They also suggest that individuals with DM incorporate flexibility and strength training exercises.

“The guidelines and the algorithm provided recommendations for managing DM comprehensively addressing all CV risk factors beyond hyperglycemia. The previous guidelines were published in 2011 and the added information to the guidelines represents advances in the past 4 to 5 years,” Dr. Handelsman told Endocrinology Advisor.

“During this time, it became apparent that people who have diabetes will benefit from vaccinations due to impairment in the immune system. We focused on hepatitis vaccines, pneumonia and others.”