Chapter 16: Endocrine and Metabolic Disorders

DIABETES MELLITUS (DM), TYPE 2

Population

• –Persons with impaired glucose tolerance (IGT).^a

Recommendations

ADA 2017

• –Nutrition therapy emphasizing portion control and foods higher in fiber with lower glycemic index.

• –Intensive lifestyle modification with a goal of sustained 7% weight loss.

• –Moderate physical activity such as brisk walking at least 150 min/wk.

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

Source

• –Diabetes Care. 2018;41(suppl 1):S1–S159.

Comments

1. Recommendations for disease prevention:

   1. Annual influenza vaccine.

   2. Pneumococcal polysaccharide vaccine if 2 y or older with one-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 2016

• –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):e328-347.

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.

Source

• –JAMA. 2017;318(22):2224-2233.

Population

• –Postmenopausal women who have had a hysterectomy.

Recommendation

USPSTF 2017

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

Source

• –JAMA. 2017;318(22):2224-2233.

Comment

1. This recommendation does not apply to women under the age of 50 y who have undergone a surgical menopause ...