The American Association of Clinical Endocrinologists released “substantially revised” clinical practice guidelines for developing a diabetes management plan, part of an effort to go beyond maintaining glycemic control and instead focus more on comprehensive care.

The guidelines task force also released an updated algorithm, presented as an illustrated treatment pathway companion to the guidelines. Both documents appear in the April issue of Endocrine Practice.

“There has been a lot of new information that it was time to incorporate into recommendation for practice,” Yehuda Handelsman, MD, FACP, FNLA, FACE, chairman of the guidelines task force, told Endocrine Today. “We, in fact, increased our recommendations from 43 to 67, adding several new chapters and areas that have developed in the past few years.”

Yehuda Handelsman

The 2015 guidelines promote individual patient goals and the development of a personalized management plan. Clinical recommendations are offered for assessing and managing obesity, lipid disorders, hypertension, kidney disease, cardiovascular disease, hypoglycemia and anti-hyperglycemic therapy to prevent complications.

Besides topics covered in the 2011 guidelines, the updated version offers new information about vaccinations, cancer risks and management of prediabetes, sleep disorders and depression among patients with diabetes. Discussions on hypertension management, nephropathy management, hypoglycemia and anti-hyperglycemic therapy were substantially revised and updated, according to task force members.

The 2015 treatment goals emphasize individual targets for weight loss, glucose, lipid and hypertension management.

“We, the clinicians, treat the whole patient, not just a narrow condition,” Handelsman said. “Therefore, we suggest a comprehensive approach, one which empowers the clinician to address and be able to manage the various conditions associated with [diabetes mellitus]. So, not just managing glucose, but also managing obesity, [hypertension], dyslipidemia, preventing heart disease, etc.”

The guidelines include an executive summary of 67 clinical practice recommendations within 24 questions covering the spectrum of diabetes management.

The algorithm, first published in 2013, emphasizes the importance of medical and surgical interventions for patients with diabetes who are overweight and obesity, as well as the prevention of diabetes in high-risk patients with prediabetes. It also includes every FDA-approved class of diabetes medications, listing various therapy options based on a patient’s HbA1c level.

“Although the new guidelines are a very comprehensive document with hundreds of references, the guidelines are written in an easy way,” Handelsman said. “It is a question-and-answer style. There are 24 questions, and the clinician can just go to his or her specific question and find the recommendation.” – by Regina Schaffer