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The guidelines recommend hepatitis B vaccinations for adults aged 20 to 59 years as soon after as possible after receiving a DM diagnosis and to consider vaccination of adults aged 60 years and older based on assessment of risk and likelihood of an adequate immune response.
“Additionally, diabetes and obesity have been associated with cancer and, in the past 5 years, many medications for diabetes were also implicated. The guidelines make sense of the whole issue and provide relevant practice recommendations,” Handelsman said.
Updated Algorithm
The diabetes management algorithm, first published in 2013, is presented as an illustrated treatment pathway companion to the guidelines.2 It emphasizes the importance of medical and surgical interventions as primary therapeutic approaches in overweight and obese patients with DM.
The algorithm also addresses prevention of diabetes in high-risk patients with prediabetes using AACE’s obesity treatment algorithm. The algorithm includes every FDA-approved class of medications for diabetes and stratifies therapy options based on initial HbA1c levels.
Alan Garber, MD, PhD, who is chair of the algorithm task force, said the updated version provides clinicians with a definitive, point-of-care tool to assess critical factors that accompany diabetes and its treatment.
In Clinical Practice
These guidelines are helpful to endocrinologists and may help improve overall DM care, according to Andrew Ahmann, MD, who is director of the Schnitzer Diabetes Center at the Oregon Health & Science University in Portland.
Ahmann noted that the guidelines were started in the 1990s, and they have influenced care and helped establish important standards and goals over the past 2 decades.
“They have been adopted by many organizations and endorsed by them. The guidelines get promoted and get republished and that has made a difference in our overall care,” Dr. Ahmann said in an interview with Endocrinology Advisor.
“The issue has become more and more complex over the years when it comes to the guidelines. There are ADA (American Diabetes Association) guidelines and some from the Endocrine Society, and primary care physicians have their own. So, it can get confusing as to how to interpret these and how to analyze the differences between different organizations.”
The newest guidelines and algorithm put a lot of pieces of small information together to help build a more complete and cohesive picture, Ahmann explained. He said there is a significant lack of controlled, prospective studies with several agents used to manage DM.
However, Ahmann said the gaps in scientific evidence are addressed in a transparent and easy to understand analysis.
“They are not perfect,” said Dr. Ahmann “We don’t have enough data. We don’t have the perfect studies so they help in that area and they excel.”
