March 3, 2014
Updated diabetes care guidelines place emphasis on the A1C blood test when testing for diabetes, a shift that could help physicians standardize diabetes screening and prevention with the consistent use of one primary test.
The American Diabetes Association’s (ADA) updated Standards of Medical Care Guidelines explain that the A1C has advantages over other diabetes tests, including greater convenience and stability and fewer factors that can skew results.
The testing recommendations in the guidelines include:
• Testing should be considered in adults of any age with a body mass index of 25 or more, and one or more of the known risk factors for diabetes.
• Because age is a major risk factor for diabetes, testing should begin at 45 years old for those without these risk factors.
• Testing should take place within the health care setting because of the need for follow-up and discussion of abnormal results.
The updated guidelines also emphasize the importance of screening for and treating prediabetes, a condition that affects 79 million Americans. Once prediabetes is confirmed in a patient, the guidelines offer such recommendations as:
• Patients with prediabetes should be referred to an effective ongoing support program.
• Overweight patients with prediabetes should aim to lose 7 percent of their body weight, and all patients with prediabetes should complete at least 150 minutes per week of moderate activity.
• Based on cost-effectiveness, health coaching programs to prevent diabetes that follow the Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program framework should be covered by third-party payers.
• Those with prediabetes should be monitored for the development of diabetes at least one each year.
These screening recommendations align with the AMA’s Improving Health Outcomes initiative. A pilot program, part of the AMA’s partnership with the YMCA of the USA, is addressing prediabetes through a proven prevention program developed by the CDC.
The YMCA of the USA is participating in a Center for Medicare & Medicaid Innovation award that pays for at-risk people over age 65 to attend an evidence-based diabetes prevention program in 17 communities across the country. The AMA and YMCA of the USA are collaborating to increase the number of Medicare participants in the YMCA’s Diabetes Prevention Program.
Physicians in the pilot program are ramping up screenings and referring people at risk for diabetes to evidence-based diabetes prevention programs at local YMCAs. Once a patient is enrolled in a program, a feedback loop of information will allow the physician to integrate the patient’s experience into the care plan for that patient.
In the future, even more patients could be covered for participating in such programs. A new Medicare bill seeks to amend the Social Security Act to provide coverage for the CDC’s National Diabetes Prevention Program to eligible beneficiaries. If adopted, the move could save $1.3 billion in federal money over the next decade, according to a study released last week by the ADA, YMCA of the USA and the AMA.
Article courtesy American Medical Association
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