Samson SL, et al. · 2023
🌱 La lettura di LEO
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tocca anche 🛡️ Protezione d'organo⚖️ Peso & grasso viscerale📉 Stabilità nel tempo
Linea guida/consensus
La domandaCome impostare, in modo pratico e visivo, la gestione complessiva del diabete tipo 2 e del prediabete secondo l'esperto clinico?
Cosa hanno trovatoConsensus statement AACE 2023 (aggiornamento dell'algoritmo 2020), sviluppato da una task force di esperti a partire dalla linea guida AACE 2022. Articolato in 11 sezioni tra cui prediabete, riduzione del rischio cardiovascolare aterosclerotico (dislipidemia, ipertensione), algoritmo glicemico complication-centric e glucose-centric, profili dei farmaci antiiperglicemizzanti e per il calo ponderale, e raccomandazioni vaccinali (ACIP/CDC). L'abstract non riporta stime d'effetto numeriche, IC o valori p.
Cosa significa per teDocumento di sintesi (consensus, non studio sperimentale): non dimostra nuovi effetti ma organizza le scelte. Messaggio operativo per il tipo 2: la modifica dello stile di vita e il trattamento di sovrappeso/obesita sono pilastri sia nel prediabete sia nel diabete, e le decisioni farmacologiche di prima linea vanno guidate dalle complicanze presenti (approccio complication-centric), non solo dal valore di glicemia. Include anche accesso e costo dei farmaci come fattori di equita. Non applicabile come tale al tipo 1 autoimmune, che richiede insulina. Ogni scelta terapeutica resta di competenza del diabetologo.
OBJECTIVE: This consensus statement provides (1) visual guidance in concise graphic algorithms to assist with clinical decision-making of health care professionals in the management of persons with type 2 diabetes mellitus to improve patient care and (2) a summary of details to support the visual guidance found in each algorithm. METHODS: The American Association of Clinical Endocrinology (AACE) selected a task force of medical experts who updated the 2020 AACE Comprehensive Type 2 Diabetes Management Algorithm based on the 2022 AACE Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan and consensus of task force authors. RESULTS: This algorithm for management of persons with type 2 diabetes includes 11 distinct sections: (1) Principles for the Management of Type 2 Diabetes; (2) Complications-Centric Model for the Care of Persons with Overweight/Obesity; (3) Prediabetes Algorithm; (4) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Dyslipidemia; (5) Atherosclerotic Cardiovascular Disease Risk Reduction Algorithm: Hypertension; (6) Complications-Centric Algorithm for Glycemic Control; (7) Glucose-Centric Algorithm for Glycemic Control; (8) Algorithm for Adding/Intensifying Insulin; (9) Profiles of Antihyperglycemic Medications; (10) Profiles of Weight-Loss Medications (new); and (11) Vaccine Recommendations for Persons with Diabetes Mellitus (new), which summarizes recommendations from the Advisory Committee on Immunization Practices of the U.S. Centers for Disease Control and Prevention. CONCLUSIONS: Aligning with the 2022 AACE diabetes guideline update, this 2023 diabetes algorithm update emphasizes lifestyle modification and treatment of overweight/obesity as key pillars in the management of prediabetes and diabetes mellitus and highlights the importance of appropriate management of atherosclerotic risk factors of dyslipidemia and hypertension. One notable new theme is an emphasis on a complication-centric approach, beyond glucose levels, to frame decisions regarding first-line pharmacologic choices for the treatment of persons with diabetes. The algorithm also includes access/cost of medications as factors related to health equity to consider in clinical decision-making.