2022 Guidelines on the management of patients with diabetes. A position of Diabetes Poland

2022 Guidelines on the management of patients with diabetes A position of Diabetes Poland Rules for diagnosing carbohydrate metabolism disordersKey recommendations• Blood sugar tests for early detection of prediabetes/type 2 diabetes should be performed for people over 45, as well as for younger overweight or obese people if there is at least one additional risk factor of diabetes.B• Women not previously diagnosed with diabetes should undergo an oral glucose tolerance test between 24 th and 28 th week of pregnancy to diagnose gestational diabetes.A• Diagnosing diabetes in children during the first 9 weeks after birth requires genetic tests for neonatal diabetes.a• Patients with cystic fibrosis aged 10 and above should undergo an oral glucose tolerance test each year to diagnose diabetes.aDiabetes is a group of metabolic diseases characterised by hyperglycaemia resulting from a defect in insulin secretion and/or activity.Chronic hyperglycaemia is associated with damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. I. Symptoms indicative of potentialdiabetes with significant hyperglycaemia:• increased diuresis (polyuria);• increased thirst;• loss of weight not explained by intentional dieting;• other, less typical symptoms: weakness and increased sleepiness, purulent skin lesions and inflammation of genitourinary organs. II. Rules for diagnosing carbohydrate metabolism disorders:• if symptoms of diabetes occur, a random blood sugar test should be performed, with result ≥ 200 mg/dl (≥ 11.1 mmol/l) constituting grounds for diagnosing diabetes;2022 Guidelines on the management of patients with diabetes A position of Diabetes Poland Prevention and delay of diabetes Key recommendations• Patients with pre-diabetes should be given recommendations on a healthy lifestyle (physical activity at least 150 min/week; in case of overweight and obese patients, weight reduction of at least 7% and weight maintenance) and information on the effectiveness of such measures in preventing the development of diabetes.a• Apart from the modification of lifestyle, pharmacological prevention of diabetes in the form of metformin should be considered in pre-diabetic patients, especially patients with concomitant IFG and IGT and/or a body mass index (BMI) ≥ 35 kg/m 2 and/or patients under 60 years of age, as well as in women with a history of gestational diabetes mellitus.a• Screening should be performed using fasting glucose, oral glucose.c Type 1 diabetesCurrently, there is no effective method of preventing type 1 diabetes either in the general population or at-risk people.Type 2 diabetes 1. Screening should be performed using fasting glucose or oral glucose tolerance test.2. Risk factors of type 2 diabetes (see chapter 1). Review of recommendations for preventing or delaying the development of diabetes:2022 Guidelines on the management of patients with diabetes A position of Diabetes Poland Monitoring of glucose Key recommendations• Most people on insulin therapy using the method of multiple daily injections should self-monitor blood glucose (SMBG) both before and after meals, at bedtime, before planned physical activity, when low blood glucose is suspected, and before activities where hypoglycaemia is particularly dangerous (e.g.driving).B 2022 Guidelines on the management of patients with diabetes A position of Diabetes Poland Setting objectives for diabetes managementKey recommendations• In individuals with diabetes, the overall target for glycaemic control expressed by the HbA 1c level is no more than 7.0% (53 mmol/mol).a• LDL fraction cholesterol less than 55 mg/dl (less than 1.4mmol/l) and a reduction of at least 50% from baseline in individuals with very high cardiovascular risk diabetes.B• LDL-C concentration less than 70 mg/dl (1.8 mmol/l) and a reduction of at least 50% from baseline in individuals with high cardiovascular risk diabetes.a• LDL-C levels less than 100 mg/dl (2.6 mmol/l) in individuals at moderate cardiovascular risk (young people under 35 yrs.with type 1 diabetes without chronic complications and other cardiovascular risk factors or with type 2 diabetes below 50 yrs.with a diabetes duration of less than 10 years, without other risk factors).a• Recommended arterial blood pressure: less than 130/80 mm Hg. a