Evidence For The Benefits
Studies have found that DSMES is associated with improved diabetes knowledge and self-care behaviors, lower A1C, lower self-reported weight, improved quality of life, reduced all-cause mortality risk, positive coping behaviors, and reduced health care costs. Better outcomes were reported for DSMES interventions that were > 10 hours over the course of 612 months.
The Definition For What Is Considered High Blood Pressure Has Been Tightened Here’s What You Need To Know
If you didn’t have high blood pressure before, there’s a good chance you do now.
In 2017, new guidelines from the American Heart Association, the American College of Cardiology, and nine other health organizations lowered the numbers for the diagnosis of hypertension to 130/80 millimeters of mercury and higher for all adults. The previous guidelines set the threshold at 140/90 mm Hg for people younger than age 65 and 150/80 mm Hg for those ages 65 and older.
This means 70% to 79% of men ages 55 and older are now classified as having hypertension. That includes many men whose blood pressure had previously been considered healthy. Why the change?
Prediabetes And Type 2 Screening Should Start At Age 35
The ADA now recommends that adults who do not have diabetes symptoms should be screened for prediabetes and type 2 diabetes starting at age 35. This change comes after the US Preventive Services Task Force lowered its recommended screening age from 45 to 35 years in August, 2021. Of the estimated 34 million US adults with diabetes in 2018, about one in five was undiagnosed. The CDC estimates that 88 million people in the US have prediabetes and that most of them dont know it and have not been made aware by their healthcare providers.
The prevalence of diabetes is rising there are many people with type 2 diabetes who are undiagnosed, and it is occurring at younger and younger ages, said Gabbay. I saw a patient who was diagnosed with diabetes after seeing his eye doctor, who determined that he already had significant retinopathy, eventually losing vision in one eye. He presumably had diabetes for a number of years but never knew it. This should not have to happen, which is why this change is important.
The guidelines also added new screening recommendations for pregnant women and those planning a pregnancy. Those at risk for diabetes who are planning to become pregnant should be screened before conception or, if not screened before conception, before they are 15 weeks pregnant. The standards also urge healthcare professionals to consider screening all those who are currently pregnant or planning to become pregnant regardless of diabetes risk.
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Treatment In Skilled Nursing Facilities And Nursing Homes
12.17 Consider diabetes education for the staff of long-term care and rehabilitation facilities to improve the management of older adults with diabetes. E
12.18 Patients with diabetes residing in long-term care facilities need careful assessment to establish individualized glycemic goals and to make appropriate choices of glucose-lowering agents based on their clinical and functional status. E
Management of diabetes in the LTC setting is unique. Individualization of health care is important in all patients however, practical guidance is needed for medical providers as well as the LTC staff and caregivers . Training should include diabetes detection and institutional quality assessment. LTC facilities should develop their own policies and procedures for prevention and management of hypoglycemia.
Everyone Agrees On Lifestyle
Although the guidelines differ in their blood pressure targets, they consistently recommend lifestyle modifications.
Lifestyle modifications, first described in JNC 7, included weight loss, sodium restriction, and the DASH diet, which is rich in fruits, vegetables, low-fat dairy products, whole grains, poultry, and fish, and low in red meat, sweets, cholesterol, and total and saturated fat.
These recommendations were based on results from 3 large randomized controlled trials in patients with and without hypertension. In patients with no history of hypertension, interventions to promote weight loss and sodium restriction significantly reduced blood pressure and the incidence of hypertension compared with usual care.,
In patients with and without hypertension, lowering sodium intake in conjunction with the DASH diet was associated with substantially larger reductions in systolic blood pressure.
The recommendation to lower sodium intake has not changed in the guideline revisions. Meanwhile, other modifications have been added, such as incorporating both aerobic and resistance exercise and moderating alcohol intake. These recommendations have a class I level of evidence in the 2017 ACC/AHA guidelines.
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Standards Of Medical Care In Diabetes2022 Abridged For Primary Care Providers
American Diabetes Association Standards of Medical Care in Diabetes2022 Abridged for Primary Care Providers. Clin Diabetes 1 January 2022 40 : 1038.
The American Diabetes Associations Standards of Medical Care in Diabetes is updated and published annually in a supplement to the January issue of Diabetes Care. The Standards are developed by the ADAs multidisciplinary Professional Practice Committee, which comprises expert diabetes health care professionals. The Standards include the most current evidence-based recommendations for diagnosing and treating adults and children with all forms of diabetes. ADAs grading system uses A, B, C, or E to show the evidence level that supports each recommendation.
AClear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered
BSupportive evidence from well-conducted cohort studies
CSupportive evidence from poorly controlled or uncontrolled studies
EExpert consensus or clinical experience
Heart Health: Importance Of Pre
Have you been asked countless times by patients why dental clinicians need to take blood pressure prior to the appointment? Are you working in an office that has yet to establish a patient triage prior to appointments? Understanding the important role that the dental clinician plays in risk assessment protocol can mean life or death to patients.
Blood pressure is the amount of pressure of circulating blood against the walls of blood vessels.1 Blood pressure consists of systolic pressure and diastolic pressure. The systolic pressure is the maximum pressure during one heartbeat, and diastolic pressure is the minimum pressure during two heartbeats. Systolic pressure is the action or pumping of the blood in comparison to the diastolic pressure that is when the heart muscle relaxes and refills with blood. The diastolic pressure is also known as the resting pressure.1
The three categories of blood pressure are hypertension or high blood pressure, hypotension or low blood pressure, and normotension or normal pressure. Hypertension is the most chronic cardiovascular condition in the United States.2 According to the Centers for Disease Control and Prevention , nearly half the adult U.S. population has hypertension.3 However, only one in four adults who are diagnosed with hypertension have the disease controlled by diet or medication.3
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Management Of Gestational Diabetes Mellitus
14.13 Lifestyle behavior change is an essential component of management of gestational diabetes mellitus and may suffice for the treatment of many women. Insulin should be added if needed to achieve glycemic targets. A
14.14 Insulin is the preferred medication for treating hyperglycemia in gestational diabetes mellitus. Metformin and glyburide should not be used as first-line agents, as both cross the placenta to the fetus. A Other oral and noninsulin injectable glucose-lowering medications lack long-term safety data.
14.15 Metformin, when used to treat polycystic ovary syndrome and induce ovulation, should be discontinued by the end of the first trimester. A
New Acc/aha High Blood Pressure Guidelines Lower Definition Of Hypertension
High blood pressure should be treated earlier with lifestyle changes and in some patients with medication at 130/80 mm Hg rather than 140/90 based on new ACC and American Heart Association guidelines for the detection, prevention, management and treatment of high blood pressure.
The new guidelines the first comprehensive set since 2003 lower the definition of high blood pressure to account for complications that can occur at lower numbers and to allow for earlier intervention. The new definition will result in nearly half of the U.S. adult population having high blood pressure, with the greatest impact expected among younger people. Additionally, the prevalence of high blood pressure is expected to triple among men under age 45, and double among women under 45, the guideline authors note. However, only a small increase is expected in the number of adults requiring antihypertensive medication.
“You’ve already doubled your risk of cardiovascular complications compared to those with a normal level of blood pressure,” said Paul K. Whelton, MB, MD, MSc, FACC, lead author of the guidelines. “We want to be straight with people if you already have a doubling of risk, you need to know about it. It doesn’t mean you need medication, but it’s a yellow light that you need to be lowering your blood pressure, mainly with non-drug approaches.”
Blood pressure categories in the new guideline are:
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Arm Cuff Vs Wrist Cuff
Although a wrist and arm blood pressure monitor both have the same goal in mind, the American Heart Association recommends an arm cuff for home monitoring.8 The reason for the AHA recommendation is that the wrist cuff may be less accurate than an arm cuff device.
Typically, wrist cuffs read higher as a result of improper technique. While using the wrist cuff, it is important to understand that the veins in the wrist are narrower than the upper arm and closer to the skin, and, therefore, the arm and wrist must be at heart level to achieve accurate readings. Although the arm cuff is recommended, an inaccurate blood pressure reading may result with an arm cuff if the proper technique is not implemented or the cuff is ill-fitted.8
The role that dental clinicians play in the patients health assessment is important to maintaining patients confidence as well as their safety. Hence, pre-operative blood pressure is key in achieving these goals. The age-old question presented by patients is, Why do I need my blood pressure taken for a dental appointment? The accurate answer and imperative objective are to understand the effects of blood pressure and dental contraindications.
Listen to the Todays RDH Dental Hygiene Podcast Below:
Adas Standards Of Medical Care In Diabetes
ADAs Standards of Medical Care in Diabetes. Clin Diabetes 1 January 2021 39 : 128.
Guidelines from the American Diabetes Association describe what should happen with your diabetes care throughout the year. These guidelines are called the Standards of Care. They list what you and your doctor need to do to take care of your diabetes. For example, some things, such as your blood pressure, should be checked every time you see your doctor. Other things, such as a dilated eye exam, should be done once a year.
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Acp/aafp 201: Systolic 150 Or 130
In 2017, the American College of Physicians and the American Academy of Family Physicians recommended a relaxed systolic blood pressure target, ie, below 150 mm Hg, for adults over age 60, but a tighter goal of less than 140 mm Hg for the same age group if they have transient ischemic attack, stroke, or high cardiovascular risk.
Expert Panel: Management Of Diabetes In Patients With Coronavirus Disease 2019
Recommendations for the management of diabetes in patients with COVID-19 were published on April 23, 2020, by an international panel of diabetes experts.
Regarding infection prevention and outpatient care:
- Patients with diabetes, particularly those with type I diabetes mellitus, should be sensitized to the importance of optimal metabolic control
- Current therapy should, if appropriate, be optimized
- Telemedicine and connected health models should be used, if possible, to maintain maximal self-containment
All patients hospitalized with COVID-19 should be monitored for new-onset diabetes.
Regarding management in the intensive care unit of infected patients with diabetes:
- Plasma glucose monitoring, electrolytes, pH, blood ketones, or -hydroxybutyrate
- There is liberal indication for early intravenous insulin therapy in severe disease courses for exact titration, with variable subcutaneous resorption avoided, and management of commonly encountered very high insulin consumption
Therapeutic goals include the following:
- Plasma glucose concentration: 4-8 mmol/L for outpatients or 4-10 mmol/L for inpatients/intensive care, with, for frail individuals, the lower value possibly adjusted upward to 5 mmol/L
- A1c < 53 mmol/mol
- Continuous glucose monitoring/flash glucose monitoring targets: Time-in-range > 70% of time
- Hypoglycemia < 3.9 mmol/L : < 4%
Fluid balance requires considerable care, as there is a risk that excess fluid can exacerbate pulmonary edema in the severely inflamed lung.
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Let’s Talk About Blood Pressure
Almost half of American adults have high blood pressure, and many dont know it. Most of the time high blood pressure has no obvious symptoms to indicate that something is wrong, but HBP can lead to heart attack, stroke, and kidney failure.
To help the community be aware of the risks and make changes that matter, the AHA created the eLearning micromodules Lets Talk About Blood Pressure.
The online modules take about 15 minutes to complete and bring awareness to the problem, explain blood pressure numbers in a way that is easily understood, present lifestyle and other treatments to lower and manage high blood pressure, and provide support in sharing this information with others in their family and community.
Its important to know about blood pressure and how to keep it in the healthy range. High blood pressure is a symptomless silent killer that quietly damages blood vessels and leads to serious health problems.
While there is no cure, using medications as prescribed and making lifestyle changes can enhance your quality of life and reduce your risk of heart disease, stroke, kidney disease and more.
Overweight Or Obesity Therapy Recommendations Now Include Wegovy Emphasize Importance Of Food Quality Over Quantity
The new guidelines also now recommend Wegovy as an effective therapy for weight management for people with type 2 diabetes. For those with type 2 who take insulin, however, using Wegovy at the same time may increase the risk for hypoglycemia. The drug can still be an effective method to achieve some weight loss, but people should get educated on the signs, symptoms, and risk of hypoglycemia before starting this medication.
The guidelines also recommend managing glucose through more than just carbohydrate-counting. Regardless of the amount of carbohydrate in the meal plan, people should focus on eating high-quality and nutrient-dense carbohydrate sources that are high in fiber. Both children and adults should limit the amount of refined or processed carbs they eat that include added sugars, fat, and salt and instead focus on getting their carbs from vegetables, legumes, fruits, dairy , and whole grains.
These updates are posted in Chapter 8 of the 2022 ADA diabetes care guidelines.
The ADA expanded recommendations for continuous glucose monitor and Time in Range use in adults and for CGM and automated insulin delivery use in children. The guidelines also include using diabetes technology in hospital settings.
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Lifestyle And Pharmacologic Interventions
Intensive lifestyle intervention focusing on weight loss through decreased caloric intake and increased physical activity as performed in the Action for Health in Diabetes trial may be considered for improving glucose control, fitness, and some ASCVD risk factors . Patients at increased ASCVD risk should receive statin, ACE inhibitor, or ARB therapy if the patient has hypertension, and possibly aspirin, unless there are contraindications to a particular drug class. Clear benefit exists for ACE inhibitor or ARB therapy in patients with diabetic kidney disease or hypertension, and these agents are recommended for hypertension management in patients with known ASCVD . -Blockers should be used in patients with active angina or HFrEF and for 3 years after MI in patients with preserved left ventricular function .
Sprint: Intensive Treatment Is Beneficial
The new ACC/AHA guidelines were based on evidence from several trials, including the Systolic Blood Pressure Intervention Trial .
This multicenter trial investigated the effect of intensive blood pressure treatment on cardiovascular disease risk. The primary outcome was a composite of myocardial infarction, acute coronary syndrome, stroke, and heart failure.
The trial enrolled 9,361 participants at least 50 years of age with systolic blood pressure 130 mm Hg or higher and at least 1 additional risk factor for cardiovascular disease. It excluded anyone with a history of diabetes mellitus, stroke, symptomatic heart failure, or end-stage renal disease.
Two interventions were compared:
Intensive treatment, with a systolic blood pressure goal of less than 120 mm Hg: the protocol called for polytherapy, even for participants who were 75 or older if their blood pressure was 140 mm Hg or higher
Standard treatment, with a systolic blood pressure goal of less than 140 mm Hg: it used polytherapy for patients whose systolic blood pressure was 160 mm Hg or higher.
Using these findings, Bress et al estimated that implementing intensive blood pressure goals could prevent 107,500 deaths annually.
The downside is adverse effects. In SPRINT, the intensive-treatment group experienced significantly higher rates of serious adverse effects than the standard-treatment group, ie:
Jnc 7 200: 140/90 Or 130/80
The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure , published in 2003, specified treatment goals of:
< 140/90 mm Hg for most patients
< 130/80 mm Hg for those with diabetes or chronic kidney disease.
JNC 7 defined hypertension as 140/90 mm Hg or higher, and introduced the classification of prehypertension for patients with a systolic blood pressure of 120 to 139 mm Hg or a diastolic blood pressure of 80 to 89 mm Hg. It advocated managing systolic hypertension in patients over age 50. It also recommended lifestyle changes such as the Dietary Approaches to Stop Hypertension diet, moderate alcohol consumption, weight loss, and a physical activity plan.
JNC 7 provided much-needed clarity and uniformity to managing hypertension. Since then, various scientific groups have published their own guidelines .
Blood pressure guidelines, 20032017