The document provides an overview of the Standards of Care in Diabetes - 2023 guidelines. It includes 17 sections that cover various aspects of diabetes care, treatment goals, and quality evaluation tools. The sections include classification and diagnosis of diabetes, prevention or delay of type 2 diabetes, medical evaluation and assessment of comorbidities, facilitating positive health behaviors, glycemic targets, pharmacologic treatment approaches, management of cardiovascular disease and other complications, and more. The guidelines are intended to provide clinicians, patients, and other stakeholders with an evidence-based framework for diabetes care and management.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Presentation given to our fellowship program about diabetic kidney disease.
2022 update discussing SGLT2i, MRA (e.g. finerenone), health economics and beyond
MANAGEMENT OF DIABETES IN CHRONIC KIDNEY DISEASE (Special reference to Use of...Dr. Om J Lakhani
Talk on MANAGEMENT OF DIABETES IN CHRONIC KIDNEY DISEASE (Special reference to Use of Metformin In CKD).
Presented on 25th June 2017 at THE METFORMIN MEET in Vadodara, India
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
I. Introduction
A. Brief explanation of World Hypertension Day
B. Importance of addressing hypertension as a global health issue
C. Overview of the objectives of the presentation
II. Understanding Hypertension
A. Definition and classification of hypertension
B. Prevalence and global burden of hypertension
C. Risk factors and causes of hypertension
D. Health implications and complications associated with hypertension
III. World Hypertension Day 2023
A. Background and significance of World Hypertension Day
B. Theme and key messages for World Hypertension Day 2023
C. Activities and events organized worldwide to raise awareness
IV. Goals and Objectives
A. Key goals set for World Hypertension Day 2023
B. Promoting prevention and early detection of hypertension
C. Encouraging healthy lifestyle modifications
D. Enhancing public knowledge about hypertension management
V. Initiatives and Campaigns
A. Overview of global initiatives and campaigns
B. Collaborations with international organizations, NGOs, and healthcare professionals
C. Campaign materials and resources available for public use
VI. Strategies for Hypertension Prevention and Control
A. Implementing population-level interventions
B. Screening and diagnosis strategies
C. Lifestyle modifications (diet, physical activity, stress management)
D. Pharmacological management and treatment guidelines
VII. Public Awareness and Education
A. Importance of raising public awareness about hypertension
B. Educational campaigns and resources for the general public
C. Role of healthcare professionals in educating patients
VIII. Impact and Achievements
A. Highlighting the impact of previous World Hypertension Day campaigns
B. Success stories and achievements in hypertension prevention and control
C. Lessons learned and areas for improvement
IX. Conclusion
A. Recap of the key points discussed
B. Call to action for individuals, communities, and policymakers
C. Encouragement to spread awareness and take steps towards hypertension prevention
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
When it comes to management of cardiovascular diseases, are achieving lipid lowering targets sufficient. Here Dr Vivek Baliga, Consultant Internal medicine discusses the additional benefits of statins in CVD in India.
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
Diabetes mellitus (DM) is a significant public health problem associated with many debilitating health conditions
This presentation will briefly tackle management of Diabetes
MANAGEMENT OF DIABETES IN CHRONIC KIDNEY DISEASE (Special reference to Use of...Dr. Om J Lakhani
Talk on MANAGEMENT OF DIABETES IN CHRONIC KIDNEY DISEASE (Special reference to Use of Metformin In CKD).
Presented on 25th June 2017 at THE METFORMIN MEET in Vadodara, India
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
I. Introduction
A. Brief explanation of World Hypertension Day
B. Importance of addressing hypertension as a global health issue
C. Overview of the objectives of the presentation
II. Understanding Hypertension
A. Definition and classification of hypertension
B. Prevalence and global burden of hypertension
C. Risk factors and causes of hypertension
D. Health implications and complications associated with hypertension
III. World Hypertension Day 2023
A. Background and significance of World Hypertension Day
B. Theme and key messages for World Hypertension Day 2023
C. Activities and events organized worldwide to raise awareness
IV. Goals and Objectives
A. Key goals set for World Hypertension Day 2023
B. Promoting prevention and early detection of hypertension
C. Encouraging healthy lifestyle modifications
D. Enhancing public knowledge about hypertension management
V. Initiatives and Campaigns
A. Overview of global initiatives and campaigns
B. Collaborations with international organizations, NGOs, and healthcare professionals
C. Campaign materials and resources available for public use
VI. Strategies for Hypertension Prevention and Control
A. Implementing population-level interventions
B. Screening and diagnosis strategies
C. Lifestyle modifications (diet, physical activity, stress management)
D. Pharmacological management and treatment guidelines
VII. Public Awareness and Education
A. Importance of raising public awareness about hypertension
B. Educational campaigns and resources for the general public
C. Role of healthcare professionals in educating patients
VIII. Impact and Achievements
A. Highlighting the impact of previous World Hypertension Day campaigns
B. Success stories and achievements in hypertension prevention and control
C. Lessons learned and areas for improvement
IX. Conclusion
A. Recap of the key points discussed
B. Call to action for individuals, communities, and policymakers
C. Encouragement to spread awareness and take steps towards hypertension prevention
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
When it comes to management of cardiovascular diseases, are achieving lipid lowering targets sufficient. Here Dr Vivek Baliga, Consultant Internal medicine discusses the additional benefits of statins in CVD in India.
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
Diabetes mellitus (DM) is a significant public health problem associated with many debilitating health conditions
This presentation will briefly tackle management of Diabetes
What Spine Surgeons Need to Know About Dietary Strategies for Heart Disease a...James McCarter
Presentation to the North American Spine Society Annual Meeting. Interdisciplinary Spine Forum: Obesity and Diabetes: Impact on the Spine and Evidence-Based Management Strategies. Organized by Dr. Carrie Diulus
Diabetes and obesity have reached epidemic proportion. It is imperative that spine providers take these factors into consideration. We also have the opportunity to be powerful motivators to our patients with some straight forward evidence-based strategies.
Upon completion of this session, participants should gain strategies to:
Understand impact of metabolic syndrome on spine conditions/degeneration and treatment outcomes
Learn dietary strategies to have a positive impact on these conditions and the most current science behind these recommendations
Understanding the impact of strategies on heart disease and lipids
How to implement recommendations in a busy clinical setting
This comprehensive program covers essential aspects of performance marketing, growth strategies, and tactics, such as search engine optimization (SEO), pay-per-click (PPC) advertising, content marketing, social media marketing, and more
Want to move your career forward? Looking to build your leadership skills while helping others learn, grow, and improve their skills? Seeking someone who can guide you in achieving these goals?
You can accomplish this through a mentoring partnership. Learn more about the PMISSC Mentoring Program, where you’ll discover the incredible benefits of becoming a mentor or mentee. This program is designed to foster professional growth, enhance skills, and build a strong network within the project management community. Whether you're looking to share your expertise or seeking guidance to advance your career, the PMI Mentoring Program offers valuable opportunities for personal and professional development.
Watch this to learn:
* Overview of the PMISSC Mentoring Program: Mission, vision, and objectives.
* Benefits for Volunteer Mentors: Professional development, networking, personal satisfaction, and recognition.
* Advantages for Mentees: Career advancement, skill development, networking, and confidence building.
* Program Structure and Expectations: Mentor-mentee matching process, program phases, and time commitment.
* Success Stories and Testimonials: Inspiring examples from past participants.
* How to Get Involved: Steps to participate and resources available for support throughout the program.
Learn how you can make a difference in the project management community and take the next step in your professional journey.
About Hector Del Castillo
Hector is VP of Professional Development at the PMI Silver Spring Chapter, and CEO of Bold PM. He's a mid-market growth product executive and changemaker. He works with mid-market product-driven software executives to solve their biggest growth problems. He scales product growth, optimizes ops and builds loyal customers. He has reduced customer churn 33%, and boosted sales 47% for clients. He makes a significant impact by building and launching world-changing AI-powered products. If you're looking for an engaging and inspiring speaker to spark creativity and innovation within your organization, set up an appointment to discuss your specific needs and identify a suitable topic to inspire your audience at your next corporate conference, symposium, executive summit, or planning retreat.
About PMI Silver Spring Chapter
We are a branch of the Project Management Institute. We offer a platform for project management professionals in Silver Spring, MD, and the DC/Baltimore metro area. Monthly meetings facilitate networking, knowledge sharing, and professional development. For event details, visit pmissc.org.
New Explore Careers and College Majors 2024.pdfDr. Mary Askew
Explore Careers and College Majors is a new online, interactive, self-guided career, major and college planning system.
The career system works on all devices!
For more Information, go to https://bit.ly/3SW5w8W
The Impact of Artificial Intelligence on Modern Society.pdfssuser3e63fc
Just a game Assignment 3
1. What has made Louis Vuitton's business model successful in the Japanese luxury market?
2. What are the opportunities and challenges for Louis Vuitton in Japan?
3. What are the specifics of the Japanese fashion luxury market?
4. How did Louis Vuitton enter into the Japanese market originally? What were the other entry strategies it adopted later to strengthen its presence?
5. Will Louis Vuitton have any new challenges arise due to the global financial crisis? How does it overcome the new challenges?Assignment 3
1. What has made Louis Vuitton's business model successful in the Japanese luxury market?
2. What are the opportunities and challenges for Louis Vuitton in Japan?
3. What are the specifics of the Japanese fashion luxury market?
4. How did Louis Vuitton enter into the Japanese market originally? What were the other entry strategies it adopted later to strengthen its presence?
5. Will Louis Vuitton have any new challenges arise due to the global financial crisis? How does it overcome the new challenges?Assignment 3
1. What has made Louis Vuitton's business model successful in the Japanese luxury market?
2. What are the opportunities and challenges for Louis Vuitton in Japan?
3. What are the specifics of the Japanese fashion luxury market?
4. How did Louis Vuitton enter into the Japanese market originally? What were the other entry strategies it adopted later to strengthen its presence?
5. Will Louis Vuitton have any new challenges arise due to the global financial crisis? How does it overcome the new challenges?
2. Intended to provide clinicians, patients,
researchers, payers, and other
interested individuals with the
components of diabetes care, general
treatment goals, and tools to evaluate
the quality of care.
The Standards.
4. | 4
Table of Contents.
1. Improving Care and Promoting Health in
Populations
2. Classification and Diagnosis of Diabetes
3. Prevention or Delay of T2D and Associated
Comorbidities
4. Comprehensive Medical Evaluation and
Assessment of Comorbidities
5. Facilitating Positive Health Behaviors and Well-
being to Improve Health Outcomes
6. Glycemic Targets
7. Diabetes Technology
8. Obesity and Weight Management for the
Prevention and Treatment of Type 2 Diabetes
9. Pharmacologic Approaches to Glycemic
Treatment
10. CVD and Risk Management
11. CKD and Risk Management
12. Retinopathy, Neuropathy, and Foot Care
13. Older Adults
14. Children and Adolescents
15. Management of Diabetes in Pregnancy
16. Diabetes Care in the Hospital
17. Diabetes and Advocacy
6. | 6
Classification
CLASSIFICATION AND DIAGNOSIS OF DIABETES
Diabetes can be classified into the following general categories:
1. Type 1 diabetes (due to autoimmune ß-cell destruction, usually leading to absolute
insulin deficiency, including latent autoimmune diabetes of adulthood)
2. Type 2 diabetes (due to a non-autoimmune progressive loss of adequate ß-cell
insulin secretion frequently on the background of insulin resistance and metabolic
syndrome)
3. Specific types of diabetes due to other causes, e.g., monogenic diabetes
syndromes (such as neonatal diabetes and maturity-onset diabetes of the young),
diseases of the exocrine pancreas (such as cystic fibrosis and pancreatitis), and
drug- or chemical-induced diabetes (such as with glucocorticoid use, in the
treatment of HIV/AIDS, or after organ transplantation)
4. Gestational diabetes mellitus (diabetes diagnosed in the second or third trimester
of pregnancy that was not clearly overt diabetes prior to gestation)
7. | 7
CLASSIFICATION AND DIAGNOSIS OF DIABETES
Hold for table 2.1
Classification and Diagnosis of Diabetes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
8. | 8
No mention of hybride forms of diabetes
ADA vs WHO classification of DM
Latent autoimmune diabetes
of adult
Ketosis prone diabetes
9. | 9
CLASSIFICATION AND DIAGNOSIS OF DIABETES
Table 2.2
Classification and Diagnosis of Diabetes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
10. | 10
Classic symptoms of hyperglycemia
Polyuria
Polydipsia
Weight loss
Polyphagia no longer considered a classic symptom
11. | 11
Screening for type 2 DM
Screening of high risk population
Screening of subject with pre – diabetes
Screening of women with GDM
Universal screening of population
12. | 12
CLASSIFICATION AND DIAGNOSIS OF DIABETES
Classification and Diagnosis of Diabetes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
13. | 13
CLASSIFICATION AND DIAGNOSIS OF DIABETES
Classification and Diagnosis of Diabetes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S19-S40
14. | 14
HBA1C maintained < 6.5 % for 3 months without use of OHA and INSULIN
Remission of DM
15. | 15
2.1b Point-of-care A1C testing for diabetes screening and diagnosis should
be restricted to U.S. Food and Drug Administration–approved devices at
laboratories proficient in performing testing of moderate complexity or
higher by trained personnel. B
UPDATE 2023
17. Prevention of DM
Life style
changes
• 150 min / week
• 7 % weight loss
Metformin
• Age 25 to 59
years with
• BMI > 35
• FBS > 110
• HBAIC >6
• Previous GDM
Pioglitazone
• Lower the risk of
stroke , MI and
progression to
DM
18. 3.1 Monitor for the development of type 2 diabetes in those with
prediabetes at least annually; modified based on individual
risk/benefit assessment. E
3.9 Statin therapy may increase the risk of type 2 diabetes in
people at high risk of developing type 2 diabetes. In such individuals,
glucose status should be monitored regularly and diabetes
prevention approaches reinforced. It is not recommended that
statins be discontinued. B
3.10 In people with a history of stroke and evidence of insulin
resistance and prediabetes, pioglitazone may be considered to
lower the risk of stroke or myocardial infarction. However, this
benefit needs to be balanced with the increased risk of weight gain,
edema, and fracture. A Lower doses may mitigate the risk of
adverse effects. C
UPDATE 2023
25. Should engage in 150 min or more of moderate – to vigorous intensity activity
weekly , spread over atleast 3 days / week
No more than 2 consecutive days without activity
Resistance training in 2 -3 sessions / week on non consecutive days
Flexibility training and balance training are recommended 2-3 times / week for older
adult with DM
EXERCISE PLAN
26. | 26
FACILITATING POSITIVE HEALTH BEHAVIORS AND WELL-BEING TO IMPROVE HEALTH
OUTCOMES
Medical Nutrition Therapy
Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S68-S96
27. | 27
FACILITATING POSITIVE HEALTH BEHAVIORS AND WELL-BEING TO IMPROVE HEALTH
OUTCOMES
Medical Nutrition Therapy (continued)
Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S68-S96
28. | 28
FACILITATING POSITIVE HEALTH BEHAVIORS AND WELL-BEING TO IMPROVE HEALTH
OUTCOMES
Medical Nutrition Therapy (continued)
Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S68-S96
29. | 29
Time restricted eating and intermittent fasting
Time restricted eating is generally easier to follow compared with alternative day
fasting or the 5:2 plan
No significant difference in weight loss when compared with contious calorie
restriction
Update 2023
34. Obesity management
5 % weight loss improves glycemia
> 10 % weight loss has disease modifying
effects and impact on long term CV mortality
500 – 750 kcal deficit required for significant
weight loss
35. | 35
OBESITY MANAGEMENT FOR THE TREATMENT OF TYPE 2 DIABETES
Obesity Management for the Treatment of Type 2 Diabetes:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S128-S139
38. Insulin as default
HBA1C > 10 % / RBS > 300 mg/dl
Features of catabolism ( significant weight loss )
Ongoing ketosis
Pregnancy
HBA1C > 9 % with 3 or more OHA
Severe organ involvement
Perioperative patients
39. | 39
PHARMACOLOGIC APPROACHES TO GLYCEMIC TREATMENT
Pharmacologic Approaches to Glycemic Management:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S140-S157
42. | 42
CARDIOVASCULAR DISEASE AND RISK MANAGEMENT
Cardiovascular Disease and Risk Management:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S158-S190
44. | 44
CARDIOVASCULAR DISEASE AND RISK MANAGEMENT
Recommendations
for the Treatment of
Confirmed
Hypertension in
People with
Diabetes (1 of 2)
Cardiovascular Disease and Risk Management:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S158-S190
45. | 45
CARDIOVASCULAR DISEASE AND RISK MANAGEMENT
Recommendations
for the Treatment of
Confirmed
Hypertension in
People with
Diabetes (2 of 2)
Cardiovascular Disease and Risk Management:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S158-S190
46. | 46
Lipid management – statins for primary prevention
Age CV risk
factors
40 - 75 nil Moderate intensity statin LDL < 100 mg/dl
40 -75 1 or
more
High intensity statin LDL < 70
Reduce LDL 50%
from base line
20- 39 + Reasonable to initiate statin
> 75 Nil Reasonable to initiate moderate intensity
statin
> 75 + Continue statin therapy
47. | 47
For people of all age with diabetes and ASCVD , high intensity
statin therapy should be added to lifestyle therapy
Target LDL < 55mg / dl ( add ezetimibe / PCSK9 inhibitors if
target not achieved
ASCVD or other CV risk factors on a statin with controlled LDL
cholesterol but elevated triglycerides ( 135 – 499) the addition of
icosapent ethyl can be considered to reduce CV risk
Lipid management – statins for
secondary prevention
48. | 48
CARDIOVASCULAR DISEASE AND RISK MANAGEMENT
Cardiovascular Disease and Risk Management:
Standards of Care in Diabetes - 2023. Diabetes Care 2023;46(Suppl. 1):S158-S190
49. | 49
Reduce cardiovascular risk
Controll of hypertension
Lipid goal achievement
Aspirin use
Avoidance of smoking
Anti hyperglycemic with CV risk reduction
Primary prevention
51. | 51
Aspirin in DM
Secondary
prevention
• HTN
• DLP
• SMOKING
• FAMILY H/O CAD
• ALBUMINURIA
Primary prevention
DM > 50 YR with one
or more hish risk
53. ACEI/ARB
recommended in moderately increased albuminuria ( 30 -299 mg/g cr)
strongly recommened in severly increased albuminuria ( >300 mg/g cr )
and or e GFR < 60
SGLT2i
In all patients with DKD , recommended to reduce CKD progression and
CV events in patient with an e GFR > 20 Ml/min/1.73m2 and urinary
albumin > 200mg/g cr
CKD and risk management
54. FINERENONE
used if e GFR > 25 Ml /min/1,73m2 and k+ < 5 mEq/L
10 mg / 20 mg once weekly
weekly e GFR , K + monitoring
CKD and risk management
56. 12.20 Gabapentinoids, serotoninnorepinephrine reuptake inhibitors,
tricyclic antidepressants, and sodium channel blockers are recommended as
initial pharmacologic treatments for neuropathic pain in diabetes. A Refer to
neurologist or pain specialist when pain control is not achieved within the
scope of practice of the treating physician. E
SNRI – duloxetine , venlafaxine , all selective SNRI
TCA – amitriptyline
Capsaicin – FDA approved for pain as 8% patch
Neuropathy
57. Sodium channel blockers – lamotrigine , lacosamide , oxcarbamazepine ,
and valproic acid
Carbamazepine not approved
Neuropathy
58. | 58
Fatty infiltration of > 5 %
Hepatic steatosis associated with inflammation and hepatocyte injury with or
without fibrosis – NASH
ASSESSMENT
FIB 4 SCORE – age , SGOT, SGPT, platelet count
Fibroelastography
NAFLD