Synopsis of the 2017 U.S. Department of Veterans Affairs/ U.S. Department of Defense Clinical Practice Guideline: Management of Type 2 Diabetes Mellitus
Diabetes is the leading cause of major complications, such as end-stage renal disease and lower extremity amputations, and is a significant contributor to ischemic heart disease, stroke, peripheral vascular disease, and vision loss (1). There has been increasing acceptance of the importance of individualizing glycemic management and assessment of risk for adverse events, especially hypoglycemia (2– 6). This is of great importance for all patients, especially older adults (aged ≥65 years) with comorbid conditions.
In 2013, 12.0 million older adults in the United States had diabetes, comprising 40% of the 30.2 million persons with the disease (7). Older adults account for an estimated 60% to 70% of the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) diabetic population (largely retirees) (VA/DoD. Unpublished data). These considerations make safe and effective diabetes management a policy priority for health care providers (physicians, nurses, dietitians, and pharmacists) and policymakers in both the VA and the DoD.
The 2017 VA/DoD Clinical Practice Guideline (CPG) for the Management of Type 2 Diabetes Mellitus in Primary Care offers health care providers an evidence-based framework to evaluate, treat, and manage persons with type 2 diabetes mellitus in the context of their individual needs and preferences (8). The current article is a summary of key CPG recommendations, which was developed with multiple stakeholders to ensure representation by a broad spectrum of clinicians. It provides practice recommendations for the care of patients with diabetes, with an emphasis on shared decision making.
Ref. Conlin P., et al. Guidelines for the management of type 2 diabetes mellitus. Ann of Intern Med. 2017; 167:655-663.
