The American Diabetes Association issued an update to the Standards of medical care in diabetes 2018. This is done through a review of the current research on diabetes and of the 2017 version. Some of the main changes are presented hereafter, and the complete document can be found in the OMENT webpage > Tools and Resources > Regulations > Technical Documents > International http://oment.uanl.mx/documentos-tecnicos/?lang=en#1471896374673-7e0b74fa-cf88.
Among these updates, it is mentioned that the social context of the patient must be taken into account, in relation to food safety and socioeconomic level, in order to determine the most adequate treatment for diabetes. There must be a referral to communitarian support, such as supervised support groups or community healthcare professionals, as required.
Due to the incidence and prevalence increase in children and adolescence in recent years, diagnosis tests must be considered to people under 18 years old without any diabetes symptoms. Criteria for screening includes that the child or adolescent is either overweight or obese (greater than 85 percentile according to age, sex and weight for height) and they have one or more of the following risk factors:
- During pregnancy, their mother had suffered from gestational diabetes developed it afterwards
- Family of first or second degree that have type 2 diabetes
- Ethnicity: Latin American, Native American, African American or Asian American
- Signs of insulin resistance such as acantosis nigricans, hypertension, dyslipidemia, polycystic ovary or low birth weight
In relation to diabetes diagnosis, it is suggested to use plasma glucose, such as fasting plasma glucose or an oral glucose tolerance test (OGTT). Diagnosis by fasting glucose is indicated over 126 mg/dL after 8 hours without eating or drinking any caloric food or beverage. On the other side, OGTT must be over 200 mg/dL, using a 75 grams of glucose diluted in water.
In case of diagnosis being unclear, a second test is recommended, using a new blood sample. If both results are above established criteria, the diagnosis is confirmed. Diagnosis through glycosylated hemoglobin is not recommended for people under 18 years, as clinical essays on efficiency of this test have not been made on this population.
In terms of diabetes treatment, education on self-management must be patient-centered, which will ensure effective measures to be adopted, improving their quality of life and disease prognosis. Technological platforms must be integrated for this purpose that can also guide doctor’s indications. This can be done through data collection using this platform, as well as an improvement in the communication of the healthcare team with the patient, allowing a more individualized treatment.
According to the most recent National Health and Nutrition Survey, 9.4% of Mexican adults suffer from diabetes. Besides, in 2016 there were 105,572 deceases due to this disease, an increase of seven thousand deaths in comparison with 2015. Thus, it is convenient to be aware of new advances on diabetes for its better diagnosis and treatment.
American Diabetes Association. Standards of medical care in diabetes 2018. Journal of clinical and applied research and education; 2018: 41(1). Available from: http://care.diabetesjournals.org/content/diacare/suppl/2017/12/08/41.Supplement_1.DC1/DC_41_S1_Combined.pdf
Ministry of Health (Mexico). 2016 National Health and Nutrition Survey. Available from: http://oment.uanl.mx/descarga/ensanut_mc2016.pdf
National Institute of Statistics and Geography. Principales causas de mortalidad por residencia habitual, grupos de edad y sexo del fallecido 2016.