New Steps Toward Better Diabetes Control

Diabetes management algorithm stresses obesity managment and individualized blood sugar goals

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) Diabetes treatment is an individual thing. Depending on patient conditions and traits, clinicians can follow a step-by-step strategy to effectively reduce risk.

The American Association of Clinical Endocrinologists (AACE) has developed a treatment algorithm for patients with type 2 diabetes.

The set of steps gives clinicians a quick reference to decide on best approaches for controlling the disease.

The new algorithm highlights obesity management and individualized blood sugar goals for diabetes and prediabetes patients.

"Lose weight to reduce diabetes risk."

Alan Garber, MD, chair of the algorithm task force and President of AACE, recently introduced the expanded guidelines, calling them “a definitive, point-of-care tool for clinicians engaged in the treatment of those who are at risk for or have developed diabetes.”

Among the algorithm’s key recommendations is that obesity management should be considered an integral part of the overall comprehensive care plan for persons with diabetes to effectively reduce morbidity, mortality and disability in the majority of patients who are obese.

Overweight and obese people have a much higher risk of developing type 2 diabetes compared to those with a healthy body weight, according to the National Heart, Lung, and Blood Institute (NHLBI). People with abdominal obesity, also known as central obesity or belly fat, are especially at risk.

Also, the algorithm suggests that a blood sugar goal of less than 6.5 percent is optimal for most diabetes patients, if it can be achieved in a safe manner.

The guidelines recommend, however, that the target be individualized based on numerous factors such as age, comorbid conditions such as heart disease, duration of diabetes, risk of hypoglycemia (abnormally low levels of blood sugar), patient adherence and life expectancy. Higher targets may be appropriate for some individuals and may change for a given individual over time.

The algorithm also addresses the management of cardiovascular disease risk factors, hypertension (high blood pressure) and hyperlipidemia (high lipid levels) in those patients with prediabetes or type 2 diabetes.

In addition, the algorithm includes every FDA-approved class of medications for diabetes and differentiates the choice of therapies based on the patient’s initial A1C (a measure of average blood sugar levels over past 3 months).

Diabetes is a metabolism disorder in which the body's blood glucose, or blood sugar, level is too high. Normally, the body breaks down food into glucose and then carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy. In diabetics, insulin levels can be low, absent, or the patient can show some resistance to their insulin.

Diabetes increases the risk of heart disease and stroke, according to the American Heart Association.

“With more than 100 million suffering from diabetes and prediabetes in the United States, there simply are not enough endocrinologists to care for all patients,” said Dr. Garber. “Thus, this algorithm is essential to assist and educate clinicians who are charged with these patients’ care.”

The new AACE recommendations were published on the AACE website in April and in the March/April issue of the AACE’s peer-reviewed scientific journal Endocrine Practice.

Reviewed by: 
Review Date: 
April 25, 2013
Last Updated:
November 11, 2013