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Standards of Medical Care in Diabetes 2013 by The ADA

Discussion in 'Diabetes Discussions' started by douglas99, Jan 23, 2014.

  1. douglas99

    douglas99 Regular

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    Last edited: Jan 27, 2015
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  2. Thommothebear

    Thommothebear Regular

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    Looks interesting, but a bit of a heavy read after midnight so will have a perusal in the morning


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  3. smartlady

    smartlady Regular

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    I read the first sentence & felt some hope ~

    "Diabetes mellitus is a chronic illness that requires continuing medical care and ongoing patient self-management
    education and support to prevent acute complications and to reduce the risk of long-term complications."

    Isn't this a contradiction to what we are usually told by hcps? i.e. "Diabetes is a progressive disease" implying that we WILL all get complications eventually.

    Is this a sign that "they" are changing their stance? Perhaps taking notice that some diabetics ARE controlling it better, (like people on here) by changing their diet (however they do it, please don't let us get into another lchf fight)!

    I feel this is real progress

    Comments?

    Smartie xx

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  4. mo1905

    mo1905 Regular

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    I think "reducing the risk of complications" doesn't mean they go away. I still am a believer in that diabetes is progressive, speed of which is down to our control and a bit of luck.


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  5. phoenix

    phoenix Regular

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    Douglas,
    Whilst you're doing your 'bedtime' reading you might like to look at the recent Canadian Gudelines.
    This link is to the summary but there is a very detailed chapter describing the evidence behind the guidelines (this chapter is just on Nutritional therapy, there is another on weight management)
    http://guidelines.diabetes.ca/Browse/Chapter11
    And just to add to it, you might like the Swedish evidence summary and guidelines.
    The Evidence summary is in English so easy to read. The guidelines are translated and rather mangled by google.
    http://www.sbu.se/upload/Publikationer/Content1/1/mat_diabetes_eng_smf_110517.pdf
    http://translate.google.com/transla...rtikelkatalog/Attachments/18471/2011-11-7.pdf
    (actually it's useful to put them in one place, then I won't have to search for them again)
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  6. CollieBoy

    CollieBoy Regular

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    Yes, If the progression due to D is reduced to almost negligible compared to that due to "Old Age" then we are on to a winner!
  7. xyzzy

    xyzzy Regular

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  8. 2christine

    2christine Regular

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  9. Yorksman

    Yorksman Regular

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    The paper still has something of the self fullfilling prophecy about it:

    "Recommendations
    Lowering A1C to below or around 7%
    Providers might reasonably suggest more stringent A1C goals (such as 6.5%)
    Less stringent A1C goals (such as 8%)"
    The Belfast Study showed that decreasing "fasting blood glucose levels from 10.4 to 7.0 mmol/L but that this abnormal level presaged the all-too-familiar deterioration of control."

    Why not encourage as many people as possible to get into the normal sub 6.0 range? There are a fair few on this forum who show that it is possible. Aim to be normal.
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  10. websuperstar

    websuperstar Rookie

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    Great find thanks Doug! Some weekend reading!
  11. Yorksman

    Yorksman Regular

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    Off you go then and see to it.
  12. tonyS54

    tonyS54 Regular

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    Thank for posting this, for some reason my post containing the link was deleted from the Diabetes UK & reduced carb thread
  13. tonyS54

    tonyS54 Regular

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    If I were to stick to those recommendations it would be a fast track to progression and insulin, my carb intake on 2500 cals would range from 280 to 375g, absolute nonsense to think a type 2 can achieve good blood sugar levels with such a high carb intake it would suggest the evidence behind the guidelines is seriously flawed.
  14. xyzzy

    xyzzy Regular

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    A good thing in the 2014 doc is that it explicitly states the UK ACCORD finding that said going under an hba1c of 7% increased rusks were proven wrong and that it's fine to aim for lower targets. That 7% number still gets trotted out by some gps ...

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  15. Daibell

    Daibell Regular

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    What a superb document; a breath of fresh air. I wonder if anyone in DUK or the NHS will read it and/or take anything on board?
  16. tonyS54

    tonyS54 Regular

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    And just were did I mention low carb in my last comment? it was merely highlighting the guidelines in the link from phoenix, the only mention was in my original reply "Thank for posting this, for some reason my post containing the link was deleted from the Diabetes UK & reduced carb thread"


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  17. janewatt

    janewatt Regular

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  18. Scardoc

    Scardoc Regular

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    After a quick scan.......which is not enough and I will read this properly when I can..........and going back to a couple of earlier comments it's worth noting that:

    The <6.5% target for A1C has an evidence level of C which is "Supporting evidence from poorly controlled or uncontrolled studies" and states "if this can be achieved without significant hypoglycemia".

    Chronic vs progressive: I don't see a great shift or difference here. I think both apply, there's no implication for me that I will get complications by the use of progressive. My ability to produce insulin will get progressively worse as (and has) time moves on. It's most definitely a chronic condition as I think it's safe to assume it will last a long time!!

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