Diabetes in the 21st Century
2010 Update
American Diabetes Association
2010 Guidelines – Diagnostic
Criteria


A1C > or = 6.5% is included as diagnostic
criteria for diabetes.
A1C = 5.7- 6.4 – at increased risk for
diabetes

Must be done by a lab method with
appropriate certification and
standardization. Point of care testing does
not qualify.
American Diabetes Association
2010 Guidelines – Treatment
Goals


A1C < 7% in general, non-pregnant adult
population.
In select persons may target closer to
normal - if can be achieved without
significant risk of hypoglycemia or
adverse events (i.e.: persons with
diagnosis of short duration, long life
expectancy, no history of CVD)
American Diabetes Association
2010 Guidelines – Treatment
Goals

Conversely, less stringent goals may be
appropriate for patients with history of
hypoglycemia, limited life expectancy,
advanced complications, extensive comorbidities or difficult to control
despite multiple modalities.
American Diabetes Association
2010 Guidelines – Dietary
Guidelines


ADA comments that the use of glycemic index
and glycemic load may add modest benefit for
glycemic control over consideration of total
carbohydrate alone.
Optimal mix of macronutrients remains
unclear. Several studies have demonstrated
some benefits of short term use of low
carbohydrate diets (<130 Gm/day) with
weight loss, improved HDL and triglycerides,
or improved A1C, however long term metabolic
effects remain unclear and monitoring is
warranted.
American Diabetes Association
2010 Guidelines – Dietary
Guidelines


Continued support of limiting intake of
saturated fats to less than 7% total
caloric intake and minimizing trans fats
Total caloric intake must be appropriate
for the weight management goal
American Diabetes Association
2010 Guidelines - Exercise


150 min per week of moderate intensity
(or 75 min vigorous intensity)
In absence of contraindications, adding
resistance training 3 times a week has
been shown to reduce insulin resistance
Medication Update





Avandia remains in limelight.
Controversy regarding evidence of increased
risk of cardiovascular morbidity and mortality.
Are the risks greater than the benefits?
As of September 2010, FDA has determined
to allow to remain on market with significant
restrictions
Patients should be advised not to stop Avandia
without consulting with their diabetes health
care provider, but to discuss treatment
changes as appropriate.
TZDs as a class are also noted to increase
bone loss and risk of fracture.
Medication Update

Liraglutide (Victoza) – GLP1 receptor agonist


Similar effects, side effects and cautions
as exenatide (Byetta)
Once a day subcutaneous dosing (start with
0.6 mg/day, increase to 1.2 mg/day after 1
week, can titrate up to 1.8 mg/day). Can be
dosed at any time of day
Medication Update


GLP1 receptor agonists noted to have a risk of
pancreatitis – screen for history of
pancreatitis, gallstones, alcohol abuse or
hypertriglyceridemia as contraindications.
Byetta has had post marketing reports of
acute renal insufficiency and renal failure.
Monitor kidney function at initiation and with
dose increases.
Medication Update
New DPP4 inhibitor
 Saxagliptin (Onglyza)
 Effects, side effects and cautions
similar to sitagliptin (Januvia)
 Dosing 2.5 – 5 mg PO QD
Resources:
NMTOD Diabetes Compendium
http://nmtod.com/diabetesresources.html
American Diabetes Association (2010). Standards
of medical care in diabetes – 2010. Diabetes Care,
33, s11-s61. Retrieved August 17, 2010 from
http://care.diabetesjournals.org/content/33/Sup
plement_1/S11.full.pdf+html.