November is Diabetes Month, which promotes awareness of diabetes, as well as education about the prevention and management of diabetes. The focus for this year is on the prevention of diabetes and prediabetes (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], 2021).
According to the Centers for Disease Control and Prevention (CDC, 2021), prediabetes affects approximately 88 million adults in the United States or 1 in 3 people. Prediabetes is diagnosed with a fasting blood glucose between 100-125 mg/dL (5.6-6.9 mmol/L) or a 2 hour post-oral glucose tolerance test of 140-199 mg/dL (7.8-11 mmol/L) or an A1C 5.7-6.4% (39-47 mmol/mol). Management of prediabetes and prevention of type II diabetes includes lifestyle changes. At least 30 minutes of physical activity five times a week is recommended. Healthier foods that are high in fiber, low in sugar and fat, and balanced meals are important. Losing 5-7% of body weight can delay or prevent the development of type II diabetes (NIDDK, 2021). National efforts focused on promoting lifestyle changes are emphasized in the American Diabetes Association’s (ADA) 2021 Standards of Medical Care in Diabetes.
The revised ADA standards of care discuss the use of continuous glucose monitoring and insulin pump delivery devices for both type I and type II diabetes. The benefits of technology along with lifestyle change and coaching are also discussed. A focus on preventing and reducing obesity with behavioral changes continues to be highlighted (ADA, 2021).
Medication recommendations are included in these standards. Pramlintide is an injectable medication based on β-cell peptide amylin, which can be used in addition to insulin with type I diabetes. It does not replace the need for insulin but may reduce A1C and body weight (ADA, 2021).
For type II diabetes, metformin continues to be the first-line recommended. The use of a glucagon-like peptide 1 receptor is preferred over insulin when possible, but the earlier introduction of insulin may be needed with symptomatic hyperglycemia or A1Cs over 10% (86 mmol/mol). Considerations for medications should also include renal and cardiac effects, risk for hypoglycemia, side effects, weight management impact, and costs. The standards also provide a decision tree for medications based on individualized risk (ADA, 2021).
Research and management of diabetes are ongoing. Diabetes is the most common comorbidity for patients and impacts multiple systems in the body. For more information about diabetes, check out the RN.com course Diabetes: Overview, Diagnosis, and Management for Healthcare Professionals.
American Diabetes Association. (2021). Standards of medical care in diabetes. Diabetes Care, 44(supp 1).
Centers for Disease Control and Prevention. (2021). Do I have prediabetes campaign?
National Diabetes Month 2021. National Diabetes Month 2021.National Institute of Diabetes and Digestive and Kidney Diseases. (2021).