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Guideline Watch

February 21, 2019

These clinical guidelines were recently released:

 

ADA Updated Care Standards for Hospitalized Patients with Diabetes

The American Diabetes Association (ADA) has released updated care standards for the management of hospitalized patients with diabetes. The key recommendations include:

  • All hospitalized patients with diabetes or hyperglycemia (blood glucose > 140 mg/dL) should undergo glycosylated hemoglobin (HbA1C) testing if not performed within the last 3 months (Evidence grade: B).
  • Initiate insulin therapy for persistent hyperglycemia (threshold of ≥ 180 mg/dL), with a target blood glucose range of 140-180 mg/dL for most critically ill and noncritically ill patients (Evidence grade: A).
  • The preferred insulin regimen for noncritically ill patients with inadequate oral intake is basal insulin or a basal plus bolus correction regimen (Evidence grade: A).
  • The preferred insulin regimen for noncritically ill patients with adequate oral intake is basal, prandial, and correction components (Evidence grade: A).
  • Relying solely on sliding scale insulin is strongly discouraged for all hospitalized patients (Evidence grade: A).
  • Review and adjust the insulin regimen in events of hypoglycemia (blood glucose < 70 mg/dL) (Evidence grade: C).
  • Patients with diabetes should receive structured discharge plans tailored to their unique diabetic needs (Evidence grade: B).

More Information.

 

USPSTF Issues Draft Recommendation on BRCA Screening

The U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation statement advising screening for BRCA1 or BRCA2 mutations in women who have family members or an ethnicity/ancestry associated with these gene mutations. Women with positive screening results should undergo genetic counseling, and genetic testing if indicated (Evidence grade: B). The USPSTF advises against screening for BRCA1 or BRCA2 mutations in women with no increased risk associated with BRCA1 or BRCA2 mutations (Evidence grade: D). This recommendation statement is consistent with the USPSTF’s previous recommendation. The draft recommendation is open for public comment until March 18, 2019. More Information.