CLINICAL GUIDELINES RESEARCH & LEADERSHIP IN THIS ISSUE. Chapter 1. Clinical Guideline for Adults With Diabetes, SP209.

Size: px

Start display at page:

Download "CLINICAL GUIDELINES RESEARCH & LEADERSHIP IN THIS ISSUE. Chapter 1. Clinical Guideline for Adults With Diabetes, SP209."

Dortha Kelly
5 years ago
Views:

1995 2018 RESEARCH & LEADERSHIP Y E A R S JUNE 2018 VOL. 24 NO. 7 IN THIS ISSUE CLINICAL GUIDELINES Chapter 1.

Clinical Nutrition Guideline for Overweight and Obese Adults With Type 2 Diabetes (T2D) or Prediabetes, or Those at High Risk for

Guideline for the Care of the Older Adult With Diabetes, SP240. Chapter 5. Clinical Guideline for of Adults With Type 2 Diabetes, SP253.

1 RESEARCH & LEADERSHIP Y E A R S JUNE 2018 VOL. 24 NO. 7 IN THIS ISSUE CLINICAL GUIDELINES Chapter 1. Clinical Guideline for Adults With Diabetes, SP209. Chapter 2. Clinical Nutrition Guideline for Overweight and Obese Adults With Type 2 Diabetes (T2D) or Prediabetes, or Those at High Risk for Developing T2D, SP226. Chapter 3. Guideline for Detection and Management of Diabetes in Pregnancy, SP232. Chapter 4. Guideline for the Care of the Older Adult With Diabetes, SP240. Chapter 5. Clinical Guideline for of Adults With Type 2 Diabetes, SP253. Top:, Boston, Massachusetts Bottom right: Patient education in the clinic, Bottom left: A test to measure blood glucose For a message from the editors and a downloadable PDF of the Joslin Clinical Guidelines: ajmc.com/link/2921 Top, bottom right photos courtesy of:

F R O M T H E C H A I R M A N Collaborating With Joslin Diabetes Center to Save Lives PUBLISHING STAFF Managed Markets Jeff Prescott, PharmD Associate Editorial Director Surabhi Dangi-Garimella, PhD

Caffrey Assistant Editor Samantha DiGrande SALES & MARKETING Director of Sales Gilbert Hernandez OPERATIONS & FINANCE Circulation Director Jon Severn Project Manager Andrea Szeszko Copy Chief

2 F R O M T H E C H A I R M A N Collaborating With Joslin Diabetes Center to Save Lives PUBLISHING STAFF Managed Markets Jeff Prescott, PharmD Associate Editorial Director Surabhi Dangi-Garimella, PhD Managing Editor Mary K. Caffrey Assistant Editor Samantha DiGrande SALES & MARKETING Director of Sales Gilbert Hernandez OPERATIONS & FINANCE Circulation Director Jon Severn Project Manager Andrea Szeszko Copy Chief Jennifer Potash Copy Editors Gayle Turim Maggie Shaw Paul Silverman Designer Brianna Gibb National Accounts Associate Ryan O Leary Vice President, Finance Leah Babitz, CPA Controller Katherine Wyckoff AT THE AMERICAN JOURNAL OF MANAGED CARE, we say it often: Collaboration saves lives. Bringing the most recent developments in research, clinical practice, and quality measurement to a wider audience gives clinicians the ability to learn from one another no matter where they practice. With this issue of Evidence-Based Diabetes Management (EBDM ), we are taking our long-term partnership with to the next level as we publish the Joslin Clinical Guidelines. Dr Robert A. Gabbay, who serves as editor in chief of EBDM, brought this idea to us last fall, and we shared his enthusiasm for bringing the best practices of the world-renowned to physicians, nurses, pharmacists, nutritionists, diabetes educators, and others who care for those learning to manage this disease. Our editorial team worked with Dr Om P. Ganda, chair of the Clinical Oversight Committee at Joslin, to organize updated editions of the guidelines, which have been in use at Joslin for several years. Drs Ganda, Gabbay, and their colleagues have ensured that the guidelines reflect the latest announcements from the FDA, as clinicians have a growing array of therapeutic options for treating people with diabetes. Most people living with type 2 diabetes receive treatment from their primary care physician, and it is our hope that sharing the Joslin Clinical Guidelines through the leading source of managed care research will serve this group of physicians as well as health plans as they strive to deliver the best care possible. CORPORATE OFFICERS Chairman and CEO Mike Hennessy, Sr Vice Chairman Jack Lepping President Mike Hennessy, Jr Chief Financial Officer Neil Glasser, CPA/CFE Operations Tom Tolvé Vice President, Editorial Services and Production Kerrie Keegan Vice President, Digital Media Jung Kim Chief Creative Officer Jeff Brown Director, Human Resources Shari Lundenberg 2 Clarke Drive, Suite 100 Cranbury, NJ (609) Copyright 2018 by Managed Care & Healthcare Communications, LLC The American Journal of Managed Care ISSN (print) & ISSN (online) is published monthly by Managed Care & Healthcare Communications, LLC, 2 Clarke Drive, Suite 100, Cranbury, NJ Copyright 2018 by Managed Care & Healthcare Communications, LLC. All rights reserved. As provided by US copyright law, no part of this publication may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, without the prior written permission of the publisher. For subscription inquiries or change of address, please call For permission to photocopy or reuse material from this journal, please contact the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923; Tel: ; Web: Reprints of articles are available in minimum quantities of 250 copies. To order custom reprints, please contact Jeff Prescott, The American Journal of Managed Care, jprescott@ajmc.com; Tel: The American Journal of Managed Care is a registered trademark of Managed Care & Healthcare Communications, LLC. Printed on acid-free paper. Sincerely, Michael J. Hennessy, Sr Chairman and CEO SP204 from the chairman SP205 from the edit o r s SP206 clinical o v e r s i g h t commit tee / working groups SP208 o v e r v i e w SP209 C h a p t e r 1. Clinical Guideline for Adults With Diabetes SAMAR HAFIDA, MD; OM P. GANDA, MD, CHAIR, CLINICAL OVERSIGHT COMMITTEE; ROBERT A. GABBAY, MD, PHD, FACP; AND THE MEMBERS OF THE JOSLIN CLINICAL OVERSIGHT COMMITTEE SP226 C h a p t e r 2. Clinical Nutrition Guideline for Overweight and Obese Adults With Type 2 Diabetes (T2D) or Prediabetes, or Those at High Risk for Developing T2D OSAMA HAMDY, MD, PHD; OM P. GANDA, MD, CHAIR, CLINICAL OVERSIGHT COMMITTEE; MELINDA MARYNIUK, MED, RD, CDE; ROBERT A. GABBAY, MD, PHD, FACP; AND THE MEMBERS OF THE JOSLIN CLINICAL OVERSIGHT COMMITTEE SP232 C h a p t e r 3. Guideline for Detection and Management of Diabetes in Pregnancy FLORENCE M. BROWN, MD; SUE-ELLEN ANDERSON- HAYNES, RD, CDE; ELIZABETH BLAIR, MSN, ANP-BC, CDE, CDTC; SHANTI SERDY, MD; ELIZABETH HALPRIN, MD; ANNA FELDMAN, MD; KAREN O BRIEN, MD; SUE GHILONI, RN, CDE; EMMY SUHL, MED, RD, CDE; JO- ANNE RIZZOTTO, MED, RD, CDE; OM P. GANDA, MD, CHAIR, CLINICAL OVERSIGHT COMMITTEE; ROBERT A. GABBAY, MD, PHD, FACP; AND THE MEMBERS OF THE JOSLIN CLINICAL OVERSIGHT COMMITTEE, WITH ADMINISTRATIVE SUPPORT FROM BREDA CURRAN. SP240 C h a p t e r 4. Guideline for the Care of the Older Adult With Diabetes MEDHA MUNSHI, MD; ELIZABETH BLAIR, MSN, ANP- BC, CDE, CDTC; OM P. GANDA, MD, CHAIR, CLINICAL OVERSIGHT COMMITTEE; ROBERT A. GABBAY, MD, PHD, FACP; AND THE MEMBERS OF THE JOSLIN GUIDELINES COMMITTEE SP253 C h a p t e r 5. Clinical Guideline for of Adults With Type 2 Diabetes OM P. GANDA MD, CHAIR, CLINICAL OVERSIGHT COMMITTEE; ALISSA SEGAL, PHARMD, CDTC; ELIZABETH BLAIR, MS, ANP-BC, CDE, CDTC; RICHARD BEASER, MD; JASON GAGLIA, MD; ELIZABETH HALPRIN, MD MD; ROBERT A. GABBAY, MD, PHD, FACP; AND THE MEMBERS OF THE JOSLIN GUIDELINES COMMITTEE SP204 JUNE 2018 AJMC.COM

F R O M T H E E D I T O R S Bringing the Joslin Clinical Guidelines to the Diabetes Care Community WITH THIS ISSUE OF Evidence-Based Diabetes Management, we present publication of the first

Although some sections of the guidelines have GANDA been in use for years, our collaboration with The American Journal of Managed Care represents our first cohesive effort to update and publish the

3 F R O M T H E E D I T O R S Bringing the Joslin Clinical Guidelines to the Diabetes Care Community WITH THIS ISSUE OF Evidence-Based Diabetes Management, we present publication of the first installment of the Joslin Clinical Guidelines, which are the principles that influence our clinical behavior every day at Joslin Diabetes Center and our affiliates and partners around the world. Although some sections of the guidelines have GANDA been in use for years, our collaboration with The American Journal of Managed Care represents our first cohesive effort to update and publish the guidelines in a searchable format, one more easily shared with audiences beyond Joslin. It is our hope that publication of the guidelines, in partnership with the leading peer-reviewed journal dedicated to research and leadership in health outcomes, will bring the Joslin Clinical GABBAY Guidelines into wider use. Through use of these guidelines, patients around the world can benefit from the knowledge, research, and practices developed over more than a century of focus on the care of people with diabetes. As explained in the overview, the Joslin Clinical Guidelines are developed by the Clinical Oversight Committee at, for which we serve as chair and ex-officio members, respectively. Our Clinical Oversight Committee includes physicians, nurses, certified diabetes educators, and behavioral health specialists who are experts in treating individuals with diabetes of all ages. More importantly, our committee members are leaders in developing strategies to help those living with diabetes self-manage their disease. Our process invites the participation of faculty with special expertise who are not on the Clinical Oversight Committee; these experts serve on working groups for individual guidelines. We thank all who have participated in the development of the guidelines over many years for your contributions. The guidelines are evidence based, and the overview explains our use of a modified form of the GRADE system (Grading of Recommendations, Assessment, Development and Evaluation). For this installment, we present the following: the Clinical ; the Clinical Nutrition Guideline for Overweight and Obese Adults With Type 2 Diabetes (T2D) or Prediabetes, or Those at High Risk for Developing T2D; the Guideline for Detection and Management of Diabetes in Pregnancy; the Guideline for the Care of the Older Adult With Diabetes; and the Clinical Guideline for Pharmacological Management of Adults With Type 2 Diabetes. With this installment, we have covered the major issues that most physicians, registered dietitians, certified diabetes educators, nurse practitioners, physician assistants, and pharmacists will encounter in clinical practice. The Clinical Guideline for of Adults With Type 2 Diabetes has been revised to reflect recent scientific advances and regulatory developments that offer more choices than ever for diabetes management. We repeat the position that announced earlier this year, when we concurred with the American Diabetes Association, the American Association of Clinical Endocrinologists, the Endocrine Society, and the American Association of s that those with diabetes should aim for glycated hemoglobin of 7% or lower, not between 7% and 8%. Is diabetes self-management challenging? Yes. But as these guidelines reflect, and as we see at the Joslin Diabetes Center every day, self-management can succeed through empowering our patients and engaging them alongside appropriate pharmacotherapy. We hope this publication serves as both a resource and an inspiration to providers who are struggling with what to do next for their patients. We invite your feedback and look forward to sharing more of the best practices developed at Joslin so that individuals with diabetes can live the best lives possible. Sincerely, Om P. Ganda, MD Medical Director of the Lipid Clinic Chair, Clinical Oversight Committee Robert A. Gabbay, MD, PhD, FACP Chief Medical Officer AJMC.COM JUNE 2018 SP205

CLINICAL OVERSIGHT COMMITTEE JOSLIN DIABETES CENTER Om P.

Clinical Oversight Committee Nutrition, Pregnancy,,

Officer, Senior Vice President Nutrition,,

Physician; Chair, Continuing Medical Education Committee

Nurse Practitioner Nutrition, Pregnancy,, Cathy Carver,

Health Care Without Walls Jerry Cavallerano, OD, PhD

School, affiliation with Joslin Diabetes Center/Beetham

Guidelines for Adults With Diabetes Elizabeth Halprin,

Committees: Pregnancy, William Hsu, MD Director of the

clinical research, Co-Director of Joslin s Asian

Pediatric, Adolescent, and Young Adult Section

Melinda Maryniuk, MEd, RD, CDE * Director, Clinical and

Joslin Geriatric Diabetes Program Older Adults Sethu

Diabetes Jo-Anne Rizzotto, MEd, RD, LDN, CDE Director of

MD Staff Physician, Kidney and Hypertension Section;

Director, Healthcare Services and Publications Guideline

4 CLINICAL OVERSIGHT COMMITTEE JOSLIN DIABETES CENTER Om P. Ganda, MD Medical Director of the Lipid Clinic Chair, Clinical Oversight Committee Nutrition, Pregnancy,, Robert Gabbay, MD, PhD, FACP (ex officio) Chief Medical Officer, Senior Vice President Nutrition,, Pharmacological Management Richard Beaser, MD Senior Physician; Chair, Continuing Medical Education Committee Elizabeth Blair, MSN, ANP-BC, CDE, CDTC * Staff Adult Nurse Practitioner Nutrition, Pregnancy,, Cathy Carver, MS, ANP-BC, CDE * Nurse Leader, Nurse Practitioner at Health Care Without Walls Jerry Cavallerano, OD, PhD Associate Professor of Ophthalmology at Harvard Medical School, affiliation with Joslin Diabetes Center/Beetham Eye Institute Samar Hafida, MD Staff Endocrinologist Guidelines for Adults With Diabetes Elizabeth Halprin, MD Clinical Director, Adult Diabetes Joslin Guideline Committees: Pregnancy, William Hsu, MD Director of the Asian Clinic, assistant investigator in the section on clinical research, Co-Director of Joslin s Asian American Diabetes Initiative Lori Laffel, MD, MPH Chief, Pediatric, Adolescent, and Young Adult Section Nutrition, Pregnancy,, Pharmacological Management Melinda Maryniuk, MEd, RD, CDE * Director, Clinical and Education Programs Nutrition Medha Munshi, MD Director, Joslin Geriatric Diabetes Program Older Adults Sethu Reddy, MD, MBA, FRCPC, FACP, MACE * Chief, Adult Diabetes Jo-Anne Rizzotto, MEd, RD, LDN, CDE Director of Educational Services Nutrition, Pregnancy Sylvia Rosas, MD Staff Physician, Kidney and Hypertension Section; Director, Latino Kidney Clinic Susan Sjostrom, JD Director, Healthcare Services and Publications Guideline for Adults With Diabetes, Nutrition, Pregnancy,, William Sullivan, MD Adult Diabetes Senior Physician Nutrition, Pregnancy, SP206 JUNE 2018 AJMC.COM

Howard Wolpert, MD * Senior Physician, Director, Joslin Institute of Technology Translation John Zrebiec, LICSW * Director, Behavioral Health Clinical WORKING GROUP MEMBERS All working group members

Clinical Oversight Committee members who served on working groups are listed below members who served on working groups only.

5 Howard Wolpert, MD * Senior Physician, Director, Joslin Institute of Technology Translation John Zrebiec, LICSW * Director, Behavioral Health Clinical WORKING GROUP MEMBERS All working group members are primarily affiliated with Joslin Diabetes Center unless otherwise noted. Clinical Oversight Committee members who served on working groups are listed below members who served on working groups only. Clinical Guidelines for Adults With Diabetes William Conners, MD * Director of the Men s Health Clinic Christopher Gibbons, MD, MMSc, FAAN Director, Neuropathy Clinic John Giurini, DPM Podiatric foot surgery, Harvard Beth Israel Deaconess Medical Center Also: Ganda, Gabbay, Beaser, Cavallerano, Hafida, Hsu, Laffel, Maryniuk, Munshi, Rizzotto, Rosas, Sjostrom, Sullivan, Zrebiec Nutrition Osama Hamdy, MD, PhD Medical Director, Obesity Clinical Program Co-chair, Nutrition Nuha El Sayed, MD Staff Physician, Director of International Training Programs at Joslin Joanna Mitri, MD, MS Staff Physician Also: Ganda, Blair, Maryniuk, Rizzotto Pregnancy Sue-Ellen Anderson-Haynes, MS, RD, CDE, CPT Nutrition Educator Florence M. Brown, MD Director, Joslin-Beth Israel Deaconess Diabetes and Pregnancy Program Anna Z. Feldman, MD Staff Physician, Harvard Beth Israel Deaconess Medical Center Suzanne Ghiloni, BSN, RN, CDE Nurse Educator Karen E. O Brien, MD Maternal and Fetal Medicine, Beth Israel Deaconess Medical Center Shanti Serdy, MD Staff Physician, Adult Diabetes Breda Curran, administrative support Also: Blair, Gabbay, Halprin, Rizzotto Mark Williams, MD Senior Staff Physician, Director of Dialysis Also: Munshi, Blair, Ganda Jason Gaglia, MD, MMSc Director of Hood Center for the Prevention of Childhood Diabetes Alissa Segal, PharmD, CDE, CDTC Associate Professor and Clinical Pharmacist Also: Ganda, Gabbay, Blair, Beaser, Halprin *Formerly with Joslin. Title reflects role at time of participation in guideline development. AJMC.COM JUNE 2018 SP207

Impact of Obesity Interventions on Managed Care

Impact of Obesity Interventions on Managed Care Established 1995 SUPPLEMENT www.ajmc.com Interventions on Managed Care Highlights n Obesity: Definition, Comorbidities, Causes, and Burden n Overweight and Obesity Management Strategies n The Role of Managed