Docstoc

Recommendations for Diabetes Screening of Asymptomatic Persons

Document Sample
Recommendations for Diabetes Screening of Asymptomatic Persons Powered By Docstoc
					Figure 1. Rates of Invasive Pneumococcal Disease among Children under Five Years Old, According to
Age and Year.
Data are from the Active Bacterial Core Surveillance from 1996 through 2001. The 1996 and 1997 rates do
not include data from New York State. Asterisks indicate P<0.05 for comparisons of the rate in 2000 or
2001 with the combined rate for 1998 and 1999.

Source: N Engle J Med 348;18 www.nejm.org May 1, 2003
Table 1. Classification and Management of Blood Pressure for Adults Aged 18 Years or Older
Table 3. Lifestyle Modifications to Manage Hypertension*

                                                                                                                                                 Appropriate Systolic BP
          Modification                                                    Recommendation                                                         Reduction, Range



                                                     Maintain normal body weight (BMI, 18.5-
      Weight Reduction                               24.9)                                                                               5-20 mm Hg/10-kg weight loss23,24

                                                     Consume a diet rich in fruits, vegetables,
   Adopt DASH easting                                and low-fat dairy products with a reduced
   plan                                              content of saturated and total fat                                                                   8-14 mm Hg25,26

                                                     Reduce dietary sodium intake to no more
         Dietary sodium                              than 100 mEq/L (2.4 g sodium or 6 g
         reduction                                   sodium chloride)                                                                                      2-8 mm Hg25-27

                                                    Engage in regular aerobic physical activity
                                                    such as brisk walking (at least 30 minutes
        Physical activity                           per day, most days of the week)                                                                        4-9 mm Hg28,29

                                                   Limit consumption to no more than 2 drinks
                                                   per day(1oz. or 30 mL ethanol [eg.24oz.
                                                   beer, 10 oz wine, or 3 oz 80-proof whiskey)
   Moderation of alcohol                           in most men and no more than 1 drink per
   consumption                                     day in women and lighter-weight persons                                                                   2-7 mm Hg30
Abbreviations: BMI, body mass index calculated as weight in kilograms divided by the square of height in meters; BP, blood pressure; DASH, Dietary Approaches to Stop Hypertension.
*For overall cardiovascular risk reduction, stop smoking. The effects of implementing these modifications are dose and time dependent and could be higher for some individuals
Figure. Algorithm for Treatment of Hypertension
BP indicates blood pressure; ACE, angiotensin-converting enzyme; ARB, angiotensin-receptor blocker; and CCB, calcium channel blocker.
            Classification of Hypertension in the Young By Age Group*
  ______________________________________________________________________
                                         _
                 Classification of Hypertension in the Young By Age Group*
___________________________________________________________________________________
                  High Normal                       Significant                   Severe
                  90-94th Percentile                Hypertension       Hypertension
                  (mm Hg)                           95-99th Percentile >99th Percentile
                                                    (mm Hg)            (mm Hg)
___________________________________________________________________________________
   ___
Newborns
   7 days                                           SBP 96-105         SBP ≥ 106
   8-30 days                                        SBP 104-109        SBP ≥ 110

Infants            SBP 104-111                 SBP 112-117         SBP ≥ 118
    (≤2 years)     DBP 70-75                   DBP 74-81           DBP ≥ 82

Children           SBP 108-115                 SBP 116-123         SBP ≥ 124
    (3-5 years)    DBP 70-75                   DBP 76-83           DBP ≥ 84

Children           SBP 114-121                 SBP 122-129         SBP ≥ 130
    (6-9 years)    DBP 74-77                   DBP 78-85           DBP ≥ 86
                    Classification of Hypertension in the Young By Age Group*
          ___________________________________(cont’d)____________________________
                                             ________
                        Classification of Hypertension in the Young By Age Group*
      ______________________________________________________________________________________
                     High Normal                          Significant           Severe
                     90-94 th Percentile                  Hypertension          Hypertension
                     (mm Hg)                              95-99th Percentile    >99th Percentile
                                                          (mm Hg)               (mm Hg)
______________________________________________________________________________________
Children                                              SBP 122-125                                                                          DBP 126-133   SBP ≥ 134
    (10-12 years)                                     DBP 78-81                                                                            DBP 82-89     DBP ≥ 90

Children                                              DBP 130-135                                                                          DBP 136-143   SBP ≥ 144
    (13-15 years)                                     DBP 80-85                                                                            DBP 86-91     DBP ≥ 92

Adolescents                                           SBP 136-141                                                                          DBP 142-149   SBP ≥ 150
    (16-18 years)                                     DBP 84-91                                                                            DBP 92-97     DBP ≥ 98

•         This classification table is adapted from the “Report of the Second Task Force on Blood Pressure Control in Children –
          1987.” Note that adult classifications differ.




Source:   The Second Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC IV) 1987
                         National Institute of Health
     NCEP Coronary Heart Disease Risk Factors Other Than LDL Cholesterol*
 ______________________________________________________________________
                                      _
Positive Risk Factors
   Age
        Men: ≥ 45 years
        Women: ≥ 55 years of premature menopause without estrogen replacement therapy

   Family history of premature coronary heart disease (definite myocardial infarction or sudden
   death)
      Father/first-degree male relative <55 years
      Mother/first-degree female relative <65 years

   Cigarette Smoking

   Hypertension ≥ 140/90 mm Hg†, or on antihypertensive medication

   Low HDL cholesterol (<40mg per dL)

   Diabetes Mellitus

Negative Risk Factors ‡
   HDL cholesterol ≥ 60mg per dL (1.55 mmol per L)
     NCEP Coronary Heart Disease Risk Factors Other Than LDL Cholesterol*
 __________________________________(cont’d______________________________
NCEP = National Cholesterol Education Program; _
                                               HDL = high density lipoprotein; LDL = low-density
Lipoprotein
•   High risk, defined as two or more coronary heart disease risk factors (after positive and
    negative factors have been summed), leads to more vigorous intervention in figures 1 and 2.
    Age (defined differently for men and for women) is treated as a risk factor because rates of
    coronary heart disease are higher in the elderly than in the young, and higher in men than in
    women of the same age. Obesity is not listed as a risk factor because is operates through other
    risk factors that are included (hypertension, hyperlipidemia, decreased HDL cholesterol and
    diabetes mellitus), but it should be considered a target for intervention, and physical activity is
    recommended as desirable for everyone. High risk due to coronary of peripheral
    atherosclerosis is addressed directly in Figure 3.

†    Confirmed by measurements on several occasions

‡    If the HDL cholesterol level is ≥ 60mg per dL (1.55 mmol per L), subtract one risk factor
     (because high HDL cholesterol levels decrease coronary heart disease risk).

Adapted from the National Cholesterol Education Program. Second Report of the National Cholesterol
 Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol
in Adult (Adult Treatment Panel II). Bethesda, MD. National Institutes of Health, National Heart, Lung,
and Blood Institute. DHHS publication no. 93-3095.

Source: JAMA June 16, 1993. Vol 269, No. 23, p. 3015-3023.
Table 4. Three Categories of Risk That Modify LDL Cholesterol Goals
   ___________________________________________________________________
   _
   Risk Category                       LDL Goal (mg/dl)
   ___________________________________________________________________
   _
   CHD and CHD risk equivalents        <100
   Multiple (2÷) risk factors*         <130
   0-1 risk factor                     <160
   ___________________________________________________________________
   _

*   Risk factors that modify the low-density lipoprotein (LDL) goal are listed in Table 3.
    CHD indicates coronary heart disease.
               Recommendations for Diabetes Screening of Asymptomatic Persons
                                         Timing of first test and repeat tests
                                      Test at age 45; repeat every three years:
                                       •    Patients 45 years of age or older

Test before age 45; repeat more frequently than every three years if patient has one or more of the
following risk factors

•   Obesity: ≥ 120% of desirable body weight or BMI ≥ 27 kg per m2
•   First-degree relative with diabetes mellitus
•   Member of high risk-ethnic group (black, Hispanic, Native American, Asian)
•   History of gestational diabetes mellitus or delivering a baby weighing more than 4,032 g (9lb.)
•   Hypertensive (≥ 140/90 mm Hg)
•   HDL cholesterol level ≤ 40 mg per dl and/or triglyceride level ≥ 250 mg per dl (2.83 mmol per L)
•   History of IGT or IFG on prior testing
_______________________________________________________________________________
    __
BMI = body mass index; HDL = high density lipoprotein; IGT = impaired glucose tolerance; IFG =
impaired fasting glucose.

Adapted with permission from Report of the Expert Committee on the Diagnosis and Classification
    of
Diabetes Mellitus. Diabetes Care 1997;02:1183-97.

Source: American Family Physician. October 15, 1998;56:6. pp 1361
D.   Smoking

Table 1. Principles of Physician Advice (p. 87)
______________________________________________________________________
Identify all smokers and deliver a clear cessation message
Personalize risk
Provide information about barriers and fears
Obtain patient commitment/contract
Follow-up
Refer patients with multiple failures
______________________________________________________________________
      Summary of Cancer Screening Recommendations for Low-Risk Patients

Medical           Screening recommendations
organization

                  Breast cancer
                  Clinical Breast Examination
AAFP              Every 1 to 2 years, ages 50 to 69; counsel women ages 40-49
                  about potential risks and benefits of mammography and clinical
                  breast examinations
ACOG              Yearly (or as appropriate general health evaluation that includes
                  examination to detect signs of premalignant or malignant
                  conditions.
ACS               Every 3 years, ages 20 to 39; yearly after age 40; monthly breast
                  self-examination beginning at age 20.
AMA               Continuation of clinical breast examinations in asymptomatic
                  women older than age 40.
CTFPHC            Yearly, ages 50 to 69
USPSTF            Insufficient evidence to recommend for or against using clinical
                  breast examination alone; optional every 1 to 2 years, ages 50 to
                  69.
      Summary of Cancer Screening Recommendations for Low-Risk Patients

Medical           Screening recommendations
organization
                  Breast cancer

                  Mammography

AAFP              Every 1 to 2 years, ages 50 to 69; counsel women ages 40 to 9
                  about potential risks and benefits of mammography and clinical
                  breast examination.
ACOG              Every 1 to 2 years starting at age 40, yearly after age 50.

ACS               Annually after age 40

AMA               Every 1 to 2 years in women ages 40 to 49; annually beginning at
                  age 50
CTFPHC            Every 1 to 2 years, ages 50 to 59

NIH               Data currently available do not warrant a universal
                  recommendation for mammography for women in their 40’s; each
                  woman should decide for herself whether to undergo
                  mammography.
USPSTF            Every 1 to 2 years, ages 50 to 69
       Summary of Cancer Screening Recommendations for Low-Risk Patients

Medical            Screening recommendations
Organization
                   Cervical cancer
AAFP               Pap test at least every 3 years to women who have ever had sexual
                   intercourse and who have a cervix

ACOG               Annual Pap test and pelvic examination beginning at age 19 or when
                   sexually active; after 3 or more test with normal results, Pap test may
                   be performed less frequently on physician’s advice
ACS                Pap test annually starting at age 18 or when sexually active; after 2
                   to 3 normal (negative) tests, continue at discretion of physician

AMA                Annual Pap test and pelvic examination starting at age 18 (or when
                   sexually active); after 3 or more normal annual Pap tests, the Pap
                   test may be performed less frequently at the physician’s discretion.
CTFPHC             Pap test annually beginning at age 18 or following initiation of sexual
                   activity; after 2 normal Pap results, perform Pap tests every 3 years
                   to age 69.
USPSTF             Pap test at least every 3 years in women who have ever had sexual
                   intercourse and who have a cervix; discontinue regular testing after
                   age 65 if Pap test results have been consistently normal.
         Summary of Cancer Screening Recommendations for Low-Risk Patients
Medical           Screening recommendations
organization
                  Colorectal cancer
AAFP              No published standards or guidelines for low-risk patients
ACOG              After age 50, annual FOBT (DRE should accompany pelvic examination;
                  sigmoidoscopy every 3 to 5 years.
ACS               After age 50, yearly FOBT plus flexible sigmoidoscopy and DRE every 5
                  years or colonoscopy and DRE every 10 years or double-contrast
                  barium enema and DRE every 5 to 10 years.
AMA               Annual FPBT beginning at age 50, and flexible sigmoidoscopy every 3
                  to 5 years beginning at age 50.
AGA               FOBT beginning at age 59 (frequency not specified); sigmoidoscopy
                  every 5 years, double-contract barium enema every 5 to 10 years or
                  colonoscopy every 10 years
CTFPHC            Insufficient evidence to recommend using FOBT screening in the
                  periodic health examination of individuals older than age 40; insufficient
                  evidence to recommend sigmoidoscopy in the periodic health
                  examination; insufficient evidence to recommend screening with
                  colonoscopy in the general population.
USPSTF            After age 50, yearly FOBT and/or sigmoidoscopy (unspecified frequency
                  for sigmoidoscopy)
      Summary of Cancer Screening Recommendations for Low-Risk Patients

Medical         Screening recommendations
organization
                Prostate Cancer

AAFP            No published standards or guidelines for low-risk patients
ACP-ASIM        Physicians should describe potential benefits and known harms of
                screening, diagnosis and treatment; listen to the patient’s concerns,
                then individualize the decision to screen.
ACS and AUA     Offer annual DRE and PSA screening, beginning at age 50, to men
                who have at least a 10 year life expectancy and to younger men at
                high risk.
AMA             Provide information regarding the risks and potential benefits of
                prostate screening.

CTFPHC and      DRE and PSA test are not recommended for the general population.
USPSTF
       Summary of Cancer Screening Recommendations for Low-Risk Patients




Medical        Screening recommendations
organization
               Skin cancer
ACS            Cancer-related checkup, including skin examination every 3 years between
               ages 20 and 40, and every year for anyone age 40 and older.
AMA            Patients should talk to their physicians about the frequency of screening for
               skin cancer (those at modestly increased risk should see a primary care
               physician annually): skin self-examination should be performed monthly
CTFPHC         Insufficient evidence to recommend for or against total-body skin
               examination of self-examination; counsel on avoiding sun exposure and
               wearing protective clothing.
USPSTF         Insufficient evidence to recommend for or against routine screening for skin
               cancer by primary care clinicians or counseling patients to perform periodic
               skin examination
      Summary of Cancer Screening Recommendations for Low-Risk Patients




Medical         Screening recommendations
organization


                Testicular cancer
ACS             Examine testicles as part of a cancer-related checkup.
CTFPHC          Insufficient evidence to recommend routine examination of tests by
                physician or by patient self-examination

USPSTF          Insufficient evidence to recommend for or against routine screening of
                asymptomatic men in the general population by physician examination
                or patient self-examination

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:1
posted:4/2/2011
language:English
pages:30