Chapter 16: Endocrine and Metabolic Disorders

DIABETES MELLITUS (DM), TYPE 2

Population

• – Persons with pre-diabetes or impaired glucose tolerance (IGT).^a

Recommendations

ADA 2020

• – A variety of eating patterns are acceptable for persons with prediabetes.

• – Employ intensive behavioral lifestyle intervention with a goal of sustained 7% weight loss.

• – Recommend moderate physical activity such as brisk walking at least 150 min/wk. Pursue tobacco cessation.

• – Consider metformin for patients at highest risk for developing diabetes (eg, BMI 35 kg/m² or greater, those age 60 y or younger, and women with prior gestational diabetes mellitus [GDM]).

• – Based on patient preference, technology-assisted diabetes prevention interventions (eg, SBGM) may be effective in preventing type 2 diabetes and should be considered.

• – At least annual monitoring for the development of type 2 diabetes.

• – Screening for and treatment of modifiable risk factors for cardiovascular disease.

Source

• – Diabetes Care. 2020;43(suppl 1):S32-S36.

Comments

1. Recommendations for disease prevention:

   1. Annual influenza vaccine.

   2. Pneumococcal polysaccharide vaccine if 2 y or older with 1-time revaccination when over 64 y.

   3. Hepatitis B vaccine series if unvaccinated and 19–59 y of age.

   4. Aspirin 81 mg daily for primary prevention if 10-y risk of significant CAD is at least 10% (by Framingham Risk Score); includes most men over 50 y and most women over 60 y.

Population

• – Persons with abnormal blood glucose or BMI >25.

Recommendation

USPSTF 2015

• – Intensive behavioral intervention to promote healthy diet and physical activity.

Source

• – Ann Intern Med. 2015;163(11):861-868.

Population

• – Children of ethnicities with higher prevalence of diabetes, such as American Indian, Alaskan Native, Mexican-American, and African-American.

Recommendations

AAP 2009

• – Counsel children with BMI >85th percentile on weight control, physical activity, and nutrition.

• – Do not use medications to prevent diabetes.

• – Nutritional interventions require familiarity with family and community culture and rely on the entire family making changes.

Source

• – Pediatrics. 2003;112(4):e328-e347.

HORMONE REPLACEMENT THERAPY TO PREVENT CHRONIC CONDITIONS

Population

• – Postmenopausal women.

Recommendation

USPSTF 2017

• – Do not use combined estrogen and progestin to prevent chronic conditions, including osteoporosis, coronary artery disease, breast cancer, and cognitive impairment.

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