Diabetes Excelente 2018

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Journal of the Formosan Medical Association xxx (xxxx) xxx
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.jfma-online.com
Clinical Practice
Executive summary of the DAROC clinical

practice guidelines for diabetes care- 2018
Diabetes Association of the Republic of China (Taiwan)*,1
Received 20 August 2018; received in revised form 7 January 2019; accepted 27 February 2019
KEYWORDS It is estimated that there were 1.73e2.20 million people with diabetes in Taiwan in 2014
Diabetes care; e2015. The executive summary briefly introduced recommendations from the Diabetes Asso-
Guideline; ciation of Republic of China (DAROC) clinical practice guidelines for diabetes care- 2018. We
Clinical described the diagnostic criteria for diabetes, pre-diabetes and gestational diabetes, and
recommendations; the screening methods for diabetes in asymptomatic subjects. Treatment goals for adults with
Diabetes association diabetes, older adults with diabetes, children and adolescents with type 1 diabetes, women
of the Republic of with gestational diabetes and inpatients were recommended. For people with type 2 diabetes,
China; we suggested an algorithm including lifestyle modification, weight control, as well as the
Taiwan consideration and selection of anti-diabetic medications. Besides, we also recommended lab-
oratory tests for metabolic monitoring, examinations for the screening of diabetic complica-
tions and the suggested testing intervals for these tests and examinations.
Copyright ª 2019, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
Based on the findings of various reports, it is estimated that of Republic of China (DAROC) clinical practice guidelines for
there were 1.73e2.20 million people with diabetes in diabetes care- 2018, "the guideline", including diagnosis
Taiwan in 2014e2015.1e3 The executive summary briefly and screening of diabetes, treatment goals, the treatment
introduced recommendations from the Diabetes Association algorithm, laboratory tests for metabolic monitoring, and
examinations for the screening of diabetic complications.
The full text of "the guideline" is available on the web (in
Chinese).4
* Contact information: Wayne Huey-Herng Sheu, President, Dia-

betes Association of the Republic of China, 10F., No.48, Huai-Ning Diagnosis of diabetes
St., Zhongzheng Dist., Taipei City 100, Taiwan, ROC.
E-mail address: diabetes.1980@gmail.com. The diagnostic criteria of diabetes are shown in Table 1; the
1
The members of the working group for the guideline and the diagnostic criteria for the category of increased risk for
contributing authors are listed in the Appendix.
https://doi.org/10.1016/j.jfma.2019.02.016
0929-6646/Copyright ª 2019, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Please cite this article as: Diabetes Association of the Republic of China (Taiwan), Executive summary of the DAROC clinical practice
guidelines for diabetes care- 2018, Journal of the Formosan Medical Association, https://doi.org/10.1016/j.jfma.2019.02.016
Downloaded for Universidad de Puerto Rico Universidad de Puerto Rico (upr@ck7.com) at University of Puerto Rico Medical Sciences Campus from ClinicalKey.com by Elsevier on
October 12, 2019. For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
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2 Diabetes Association of the Republic of China (Taiwan)
Table 1 Criteria for the diagnosis of diabetes.9

1. Hemoglobin A1c 6.5%a or
2. Fasting plasma glucose 126 mg/dL (7.0 mmol/L)b or
3. 2-h plasma glucose 200 mg/dL (11.1 mmol/L) during an OGTTc or
4. Classic symptoms of hyperglycemia or hyperglycemic crisis, and a random plasma glucose 200 mg/dL (11.1 mmol/L)
Diabetes is diagnosed if one of the above criteria is met. Results should be confirmed by repeat testing in the presence of equivocal
hyperglycemia.
a
The test should be performed in a laboratory using a method that is certified by the National Glycohemoglobin Standarization
Program (NGSP) and is standardized to the Diabetes Control and Complications Trial (DCCT) assay.
b
Fasting is defined as no caloric intake for at least 8 h.
c
Oral glucose tolerance test (OGTT). The test should be performed as described by the World Health Organization (WHO), using a
glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water.
Table 2 Categories of increased risk for diabetes (prediabetes).9

1. Impaired glucose tolerance (IGT): 2-h plasma glucose in the 75-g OGTT 140e199 mg/dL (7.8e11.0 mmol/L)
2. Impaired fasting glucose (IFG): FPG 100e125 mg/dL (5.6e6.9 mmol/L)
3. Hemoglobin A1c 5.7e6.4%
FPG, fasting plasma glucose.
Table 3 The differential diagnosis between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).10,11
T1DM T2DM
Age at onset Usually younger than 30 years old Usually older than 40 years old
Onset Acute e usually symptomatic Insidious e usually asymptomatic
Clinical manifestation Thin or normal weight Obese
Body weight loss Family history of T2DM
Polyuria May accompany with acanthosis
Polydipsia nigricans or polycystic ovary
syndrome
Ketoacidosis Common Rare
Fasting C-peptide Low or undetectable Normal, decreased or increased
C-peptide after glucagon stimulation test Low or undetectable Normal, decreased or increased
Autoantibody (such as ICA, GADA, IA-2A, IAA Usually present Usually absent
and ZnT8Aba)
Treatment Insulin required Lifestyle modification and/or anti-
diabetic drugs including insulin
Presence of other autoimmune diseases Usually present Rare
a
ICA, islet cell cytoplasmic autoantibodies; GADA, glutamic acid decarboxylase autoantibodies; IA-2A, insulinoma-associated-2 au-
toantibodies; IAA, insulin autoantibodies; ZnT8Ab, zinc transporter 8 autoantibodies.
diabetes (pre-diabetes) are demonstrated in Table 2. Table National Health Insurance in Taiwan, one is based on
3 summarized clinical and laboratory features for the Taiwan Diabetes Risk Scores, and the other one is based on
classification of diabetes. In Table 4, the diagnostic criteria risk factors of diabetes. For these high-risk groups, the
for gestational diabetes mellitus (GDM) are shown. recommended screening algorithm is summarized in Fig. 1.
Screening for diabetes in asymptomatic Treatment goals

subjects
Table 6 summarized the treatment goals for non-pregnant
There are three different screening methods suggested by adults with diabetes. The treatment goals for older adults
the guideline (Table 5). One is based on the service by the with diabetes are listed in Table 7. Factors for
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DAROC Guideline for Diabetes Care- 2018 3
Table 4 Diagnosis of gestational diabetes mellitus (GDM).12,13

Plasma glucose, mg/dL (mmol/L) 75-g OGTTa 100-g OGTTb
“one-step strategy” “two-step strategy”
Fasting 92 (5.1) 95 (5.3)
1-h plasma glucose during an OGTT 180 (10.0) 180 (10.0)
2-h plasma glucose during an OGTT 153 (8.5) 155 (8.6)
3-h plasma glucose during an OGTT 140 (7.8)
OGTT, oral glucose tolerance test.
a
At first prenatal visit, check fasting plasma glucose or hemoglobin A1c to exclude preexisting diabetes (if fasting plasma
glucose 126 mg/dl or hemoglobin A1c 6.5%). At 24th-28th gestational week, perform a 75-g OGTT and measure plasma glucose at
fasting, 1h and 2h during the OGTT. The OGTT should be performed in the morning after an overnight fast of at least 8 h. The diagnosis of
GDM is made when one of the plasma glucose values meets or exceeds the cutoffs. This method is called "one-step strategy" by the
American Diabetes Association.
b
At 24th-28th gestational week, perform a nonfasting 50-g glucose challenge test in women not previously diagnosed with overt
diabetes. If the plasma glucose level measured 1 h after the glucose challenge test is 130 mg/dL (sensitivity is 90%) or 140 mg/dL
(sensitivity is 80%), proceed to a 100-g OGTT. The 100-g OGTT should be performed when the patient is fasting. The diagnosis of GDM is
made if at least two of the four plasma glucose levels (measured at fasting, 1 h, 2 h and 3 h during the OGTT) meet or exceed the cutoffs.
This method is called "two-step strategy" by the American Diabetes Association.
Table 5 Criteria for the screening for diabetes in asymptomatic adults.9,14e18

1. In adults aged 40e64 years, screening for diabetes every 3 years should be considered. For adults aged 65 or over, annual
screening for diabetes is recommended.a
2. Using risk assessment calculator, the Taiwan Diabetes Risk Score, to estimate the risk for undiagnosed diabetes.b For subjects
with very high risk of undiagnosed diabetes, annual screening is recommended. For subjects with high or moderate risk of
undiagnosed diabetes, screening every 3 years is recommended.
3. Screening should be considered if condition A or condition B is met.c
A. Screening is recommended if the subject has two or more of the following risk factors. If the screening result excludes the
presence of diabetes, repeated screening at least every 3 years is recommended.
- body mass index (BMI) 24 kg/m2 or waist circumference 90 cm in men or waist circumference 80 cm in women
- first-degree relative with diabetes
- history of cardiovascular disease
- hypertension (BP 140/90 mmHg or receiving therapy for hypertension)
- plasma HDL cholesterol <35 mg/dL or plasma triglyceride 250 mg/dL
- women with polycystic ovary syndrome
- women with a history of gestational diabetes mellitus
- physical inactivity
- clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans)
B. Subjects who have impaired fasting glucose, impaired glucose tolerance, or hemoglobin A1c 5.7e6.4% are suggested to be
tested annually.
a
Based on the service provided by Health Promotion Administration, Ministry of Health and Welfare in Taiwan.
b
In men, X Z 8.3805 þ age (years) * 0.0325 þ waist circumference (cm) * 0.0423 þ 0.5866 if anti-hypertensive drugs are
used þ 0.2429 if family history of diabetes is present. In women, X Z 9.523 þ age (years) * 0.0446 þ waist circumference (cm) *
0.0468 þ 0.4264 if anti-hypertensive drugs are used þ 0.5060 if family history of diabetes is present. A family history of diabetes is
defined if one of grandparents, parents or siblings has diabetes. The risk of undiagnosed diabetes is calculated by 1/(1 þ eX). The
patient is categorized as very high risk, high risk, moderate risk or low risk, if the calculated risk is >20%, 10e20%, 5e10% or <5%,
respectively.
c
Modified from the “2018 ADA Standards of Medical Care in Diabetes”.
individualized treatment goals are shown in Table 8. For hypoglycemia. Besides, blood glucose goals can be modi-
children and adolescents with type 1 diabetes, the general fied in children with frequent hypoglycemia, hypoglyce-
glycemic goals are defined as below: 90e130 mg/dL for mia unawareness or extreme fluctuations of blood
fasting plasma glucose, 90e150 mg/dL for bedtime plasma glucose. In these situations, consider continuous glucose
glucose and HbA1c < 7.5%.5 In clinical practice, goals monitoring (CGM). In children on basal-bolus insulin regi-
should be individualized. A lower HbA1c goal (<7.0%) may mens, postprandial blood glucose should be measured
be set if it can be achieved without excessive when there is a discrepancy between fasting plasma
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- The general target of HbA1c is <7%, with individual

considerations.
- The selection of anti-diabetic medications should be
individualized according to patient’s age and comor-
bidities, the efficacy and adverse effects of the drugs,
and the risk of hypoglycemia.
- Combination of two anti-diabetic agents is recom-
mended if HbA1c is higher than 8.5%.
- Insulin injection is preferred if typical symptoms of hy-
perglycemia are present. After blood glucose is stabi-
lized, insulin therapy can be continued or discontinued.
- Biguanide (metformin) is the preferred initial pharma-
cological agent for type 2 diabetes if it is not contra-
Figure 1 The recommended algorithm for the screening of
indicated and is tolerated.
diabetes.25 FPG, fasting plasma glucose, HbA1c, hemoglobin
- If the glycemic goal is not achieved three months after
A1c. * Other conditions include FPG<100 mg/dL and
monotherapy, consider another anti-diabetic medication
6.1% HbA1c <6.5%, as well as 100 mg/dL FPG <126 mg/dL
with different mechanisms.
and HbA1c<6.5%.
- In patients with cardiovascular diseases, consider med-
ications which have shown beneficial effects on cardio-
glucose values and HbA1c levels. For women with GDM,
vascular diseases and/or mortality, such as GLP-1
Table 9 summarized the glycemic goals.
receptor agonists, SGLT2 inhibitors and
thiazolidinediones.
- If the glycemic goal is not achieved three months after
Treatment algorithm for people with type 2 dual anti-diabetic medications, consider a third anti-
diabetic agent with different mechanisms.
diabetes
- If the glycemic target is not achieved three months
after triple anti-diabetic medications, consider inten-
Fig. 2 summarized the treatment algorithm for people with sified insulin therapy, including basal insulin plus 1e3
type 2 diabetes. When applying this treatment algorithm in doses of pre-prandial insulin or 2e3 doses of premixed
clinical situations, consider following points. insulin.
- Combination therapy of thiazolidinedione and insulin
- A healthy lifestyle is the foundation for the treatment can increase the risk of fluid retention and heart failure.
for diabetes. Close monitoring of cardiac function is suggested.
- Weight control is essential in patients with diabetes and
obesity.
Table 6 Treatment goals for non-pregnant adults with diabetes.5,17,19

Plasma glucose HbA1c <7.0 %a
Fasting or pre-prandial glucose 80e130 mg/dL
2-h postprandial glucose 80e160 mg/dL
Blood pressure General target <140/90 mmHg
Diabetic nephropathy <130/80 mmHg
Lipid (primary goal) LDL cholesterol <100 mg/dL
<70 mg/dL (in individuals with cardiovascular disease)
Lipid (secondary goal) Total cholesterol <160 mg/dL
Non-HDL cholesterol <130 mg/dL
<100 mg/dL (in individuals with cardiovascular disease)
HDL cholesterol Men: >40 mg/dL
Women: >50 mg/dL
Triglyceride <150 mg/dL
Lifestyle modification Smoking cessation Strongly recommended
Physical activity At least 150 min/week of moderate-intensity exercise,
or at least 3 days/week, 20 min/day of moderate-to-
vigorous-intensity exercise
BMI 18.5e24 kg/m2
Waist circumference Men: <90 cm
Women: <80 cm
BMI, body mass index; HbA1c, hemoglobin A1c; HDL, high density lipoprotein; LDL, low-density lipoprotein.
a
Goals should be individualized. Please refer to Table 8 for the considerations for individualized goals.
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Table 7 Treatment goals for older adults with diabetes.5

Health status HbA1c FPG Bedtime glucose Blood pressure
Healthy (few coexisting chronic illness, intact <7.5% 90e130 mg/dL 90e150 mg/dL <140/90 mmHg
cognitive and functional status)
Complex/intermediate (multiple coexisting <8.0% 90e150 mg/dL 100e180 mg/dL <140/90 mmHg
chronic illnessesa or more than 2 instrumental
ADL impairments or mild-to-moderate
cognitive impairment)
Very complex/poor health (long-term care or end- <8.5% 100e180 mg/dL 110e200 mg/dL <150/90 mmHg
stage chronic illnessesb or moderate-to-severe
cognitive impairment or 2 þ ADL
dependencies)
ADL, activities of daily living; FPG, fasting plasma glucose; HbA1c, hemoglobin A1c.
a
Coexisting chronic illnesses are conditions serious enough to require medications or lifestyle management and may include arthritis,
cancer, congestive heart failure, depression, emphysema, falls, hypertension, incontinence, stage 3 or worse chronic kidney disease,
myocardial infarction and stroke.
b
The presence of a single end-stage chronic illness, such as stage 3e4 congestive heart failure or oxygen-dependent lung disease,
chronic kidney disease requiring dialysis, or uncontrolled metastatic cancer, may cause significant symptoms or impairment of functional
status and significantly reduce life expectancy.
Table 8 Individualized goals for glycemic control.

Targets of glycemic control More strict targets Less strict targets
(e.g. HbA1c < 6.5%) (e.g. HbA1c < 8.5%)
Risk of hypoglycemia or Low High
other treatment-related
adverse events
Duration of diabetes Short (e.g. less than 5 years) Long
Life expectancy Lo n g Short
Associated comorbidities No Severe
Diabetic microvascular and No or mild Severe
macrovascular complications
Attitude and compliance of Act iv e P assi v e
patients and family
Medical resources and Go od Limited
supporting systems
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Table 9 Glycemic goals for women with gestational dia-

Recommendations of laboratory tests for
betes mellitus.20,21 metabolic monitoring and examinations for the
Pre-prandial plasma glucose <95 mg/dL screening of diabetic complications
One-hour post-meal plasma glucose <140 mg/dL
Two-hour post-meal plasma glucose <120 mg/dL The recommended tests and examinations, as well as the
Glycated albumin <15.8% suggested testing intervals are summarized in Table 10.
Glycemic control for inpatients

- If the glycemic target is not achieved within 3e12
The glycemic goal for most patients is 140e180 mg/dL,
months, consider referral to endocrinologists.
including critical and non-critical patients.6e8 A more
- Bariatric surgery can be considered for adults with
stringent goal of glycemic control (eg. <140 mg/dL) can be
moderate or severe obesity (body mass index 32.5 kg/
considered in selected patients in the prerequisite of
m2) and type 2 diabetes.
minimization of hypoglycemic risks. In the presence of
Figure 2 The treatment algorithm for patients with type 2 diabetes mellitus. The algorithm has been revised in response to the
consensus by the American Diabetes Association and the European Association for the Study of Diabetes and the results from
cardiovascular outcome trials published in 2018. * Metformin is considered as the first-line therapy for patients with newly-diag-
nosed type 2 diabetes mellitus if it is not contraindicated. y Presence of symptoms and signs of hyperglycemia. z except for
saxagliptin. x beneficial for liraglutide, semaglutide and albiglutide. k beneficial for liraglutide and semaglutide. AGI, alpha-
glucosidase inhibitors; ASCVD, evidence on the risk of atherosclerotic cardiovascular diseases; DKA, diabetic ketoacidosis; DKD,
evidence on the risk of diabetic kidney diseases; DPP4i, dipeptidyl peptidase IV inhibitors; GLP1-RA, glucagon-like peptide-1 re-
ceptor agonists; GI, gastrointestional side effects; GTI, genital tract infection; HF, evidence on the risk of heart failure; Hypo risk,
risk of hypoglycemia. SGLT2i, sodium- glucose cotransporter 2 inhibitor; SU, sulfonylurea; TZD, thiazolidinediones.
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Table 10 Recommendations of laboratory tests for metabolic monitoring and examinations for the screening of diabetic
complications.22e24
Laboratory tests or examinations Suggested testing intervals
a
Plasma glucose and HbA1c Every 3 months
Diabetes self-management education Every 3 months
Lipid profile, including LDL-cholesterol, HDL-cholesterol, total Every 1 year
cholesterol and triglyceride In people with dyslipidemia or under therapy for
dyslipidemia, tests can be repeated every 3e6
months
Tests for nephropathy, including serum creatinine, estimated Every 1 year
glomerular filtration rate (eGFR), urinalysis and/or urinary In the presence of abnormal results, tests can be
albumin excretionb repeated every 3e6 months.
Examinations for retinopathy, including visual acuity and Every 1 year
fundoscopic examinationc
Examinations for diabetic foot, including palpation of pedal Every 1 year
pulses and measurement of ankle-brachial indexd
Examinations for neuropathy: 10-g monofilament test, Every 1 year
vibration tests with 128-Hz tuning fork and tests for ankle
reflexes
Periodontal and dental examinations Every 1 year
Screening for certain cancers According to the recommendations and services
provided by the Health Promotion Administration,
Ministry of Health and Welfare in Taiwan
Diabetes self-management, including measuring body weight, Frequently
blood pressure, self-monitoring of blood glucose and foot
care.
Evaluation of anxiety and depression For high risk patients or in the presence of clinical
symptoms and/or signs
a
In patients with anemia, hemoglobin variants, chronic kidney disease or pregnancy, it is possible that there are discrepancies be-
tween HbA1c values and mean plasma glucose concentrations. In these conditions, consider glycated albumin and/or self-monitoring of
blood glucose to evaluate glycemic control.
b
Proteinuria can be detected with urine dipstick testing. If the result by dipstick testing is negative, consider urinary albumin-to-
creatinine ratio (UACR) if it is available. Proteinuria or albuminuria is diagnosed if two out of three tests within a 3- to 6-month
period are abnormal.
c
Assessment frequency is based on the result of fundoscopic examination. If there is no evidence of retinopathy, annual follow-up is
recommended. If retinopathy is progressing, examinations can be repeated every 3e6 months. During pregnancy, a more frequent
follow-up plan is suggested. Referral to an ophthalmologist is suggested in the following conditions: 1. If the patient experiences sudden
visual loss and/or symptoms/signs of retinal detachment, referral within 24 hours is suggested. 2. If the patient has pre-retinal and/or
vitreous hemorrhage, neovascularization, or iritis, referral within a week is suggested. 3. If the patient has severe diabetic retinopathy,
unexplained vision loss, macular edema, unexplained or equivocal findings from fundoscopy, cataract, or the fundus cannot be assessed,
referral within 1e2 months is suggested.
d
If the patient has foot ulcer or infection, referral to specialized team for foot care is suggested.
hypoglycemia (blood glucose < 70 mg/dL), review and General Hospital, Taiwan); Chih-Hsun Chu (Division of
adjust (if indicated) anti-diabetic medications. Endocrinology and Metabolism, Department of Medicine,
Kaohsiung Veterans General Hospital); Lee-Ming Chuang
(Department of Internal Medicine, National Taiwan Univer-
Conflicts of interest sity Hospital, Taipei); Low-Tone Ho (Departments of Internal
Medicine and Medical Research Taipei Veterans General
The authors have no conflicts of interest to declare. Hospital, Taipei); Yi-Jen Hung (Department of internal
medicine, Tri-Service General Hospital Song-Shan Branch,
Appendix Taipei); Chun Heng Kuo (Department of Internal Medicine, Fu
Jen Catholic University Hospital); Hung-Yuan Li (Division of
Working group (listed according to last name Endocrinology and Metabolism, Department of Internal
alphabetically): Medicine, National Taiwan University Hospital, Taipei,
Jung-Fu Chen (Department of Endocrinology and Meta- Taiwan); Chia-Hung Lin (Division of Endocrinology and
bolism of Kaohsiung Chang Gung Memorial Hospital and Metabolism, Department of Internal Medicine, Chang Gung
Chang Gung University College of Medicine, Kaohsiung, Memorial Hospital, Linkou, Taiwan); Kun-Der Lin (Depart-
Taiwan); Harn-Shen Chen (Division of Endocrinology and ment of Internal Medicine, Kaohsiung Municipal Ta-Tung
Metabolism, Department of Medicine, Taipei Veterans Hospital, College of Medicine, Kaohsiung Medical
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University); Shih-Yi Lin (1. Center for Geriatrics and Geron- Wei Wen Hung (Division of Endocrinology and Metabolism,
tology , Taichung Veterans General Hospital, Taichung, Department of Internal Medicine, Kaohsiung Medical Uni-
Taiwan; 2. Division of Endocrinology and Metabolism, versity Hospital, Kaohsiung); Yi-Jen Hung (Department of
Department of Internal Medicine, Taichung Veterans General internal medicine, Tri-Service General Hospital Song-Shan
Hospital, Taichung, Taiwan); Yi-Jing Sheen (Division of Branch, Taipei); Chii-Min Hwu (Section of Endocrinology and
Endocrinology and Metabolism, Department of Internal Metabolism, Department of Medicine; Taipei Veterans
Medicine, Taichung Veterans General Hospital); Wayne Huey- General Hospital, Taipei, Taiwan); Jiann-Shing Jeng
Herng Sheu (Division of Endocrinology and Metabolism, (Department of Neurology, National Taiwan University
Department of Internal Medicine, Taichung Veterans General Hospital, Taipei); Yi-Der Jiang (Department of Internal
Hospital, Taichung, Taiwan); Shyi-Jang Shin (Department of Medicine, National Taiwan University Hospital, Taipei); Jyh-
Internal edicine, Kaohsiung Medical University Hospital, Ming Jimmy Juang (Cardiovascular Center and Division of
Kaohsiung); Shih-Tzer Tsai (Division of Endocrine and Meta- Cardiology, Department of Internal Medicine, National
bolism, Department of Medicine, Cheng Hsin General Hos- Taiwan University Hospital and National Taiwan University
pital, Taipei); Shih Te Tu (Department of internal medicine, College of Medicine, Taipei, Taiwan); Jyuhn-Huarng Juang
Changhua Christian hospital). (1. Division of Endocrinology and Metabolism and Center for
Contributing authors (listed according to last name Tissue Engineering, Chang Gung Memorial Hospital,
alphabetically): Taoyuan, Taiwan; 2. Department of Medicine, College of
Chyi-Huey Bai (Department of public health, college of Medicine, Chang Gung University, Taoyuan, Taiwan); Chin-
medicine, Taipei medical university, Taipei; school of Sung Kuo (1.Division of Endocrinology and Metabolism,
public health, college of public health, Taipei medical Department of Internal Medicine, Taipei Veterans General
university, Taipei, Taiwan); Yi-Cheng Chang (Department of Hospital, Taipei; 2. Institute of Clinical Medicine, National
Internal Medicine, National Taiwan University Hospital, Yang-Ming University, Taipei, Taiwan); Chun Heng Kuo(De-
Taipei); Tien-Jyun Chang (Department of Internal Medicine, partment of Internal Medicine, Fu Jen Catholic University
National Taiwan University Hospital, Taipei); Chia-Hsuin Hospital); Jeng-Fu Kuo(Section of Endocrinology and Meta-
Chang (Department of Internal Medicine, National Taiwan bolism, Department of Medicine, Changhua Christian Hos-
University Hospital, Taipei); Chih-Jen Chang (Department pital); Ching Fai Kwok (Division of Endocrine and
of Family Medicine, National Cheng Kung University Hospi- Metabolism, Department of Medicine, Cheng Hsin General
tal, Tainan); Chi-Chao Chao (Department of Neurology, Hospital, Taipei); Ying-Chuen Lai (Department of Internal
National Taiwan University Hospital, Taipei); Jung-Fu Chen Medicine, National Taiwan University Hospital, Taipei,
(Department of Endocrinology and Metabolism of Chang Taiwan); Mei-Yueh Lee (Division of Endocrinology and
Gung Memorial Hospital at Kaohsiung); Ching-Chu Chen Metabolism, Department of Internal Medicine , Kaohsiung
(1.Division of Endocrinology and Metabolism, Department Municipal HsiaoKang Hospital , Kaohsiung Medical University
of Internal Medicine, China Medical University Hospital, Hospital , Kaohsiung City); Yann-Jinn Lee (Department of
Taichung; 2. School of Chinese Medicine, China Medical Pediatric Endocrinology, MacKay Children’s Hospital; Lab-
University, Taichung); Yen-Ling Chen (Division of Endocri- oratory of Molecular Medicine, Department of Medical
nology and Metabolism, Department of Internal Medicine, Research, MacKay Memorial Hospital, Taipei; Institute of
Shin-Kong Wu Ho-Su memorial Hospital, Taipei); Harn-Shen Biomedical Sciences and Department of Medicine, MacKay
Chen (Division of Endocrinology and Metabolism, Depart- Medical College, New Taipei City); I-Te Lee (Division of
ment of Medicine, Taipei Veterans General Hospital, Endocrinology and Metabolism, Department of Internal
Taiwan); Keong Chong (Department of Internal Medicine, Medicine, Taichung Veterans General Hospital, Taichung);
Min-Sheng General Hospital, Taoyuan); Chih-Hsun Chu (Di- Chien-Nan Lee (Department of Obstetrics and Gynecology,
vision of Endocrinology and Metabolism, Department of National Taiwan University Hospital, Taipei, Taiwan); Yen-
Medicine, Kaohsiung Veterans General Hospital ); Lee-Ming Tzu Lee (Health Education Center, Lukang Christian Hospi-
Chuang (Department of Internal Medicine, National Taiwan tal, Changhua); Ting-I Lee (1. Department of General
University Hospital, Taipei); Wu-Lung Chuang (Department Medicine, School of Medicine, College of Medicine, Taipei
of endocrinology, Lukang Christian Hospital, Chuanghua); Medical University, Taipei, Taiwan; 2. Department of In-
Li-Yuan Guo (Division of Endocrinology and Metabolism, ternal Medicine, School of Medicine, College of Medicine,
Changhua Christian Hospital, Changhua); Low-Tone Ho Taipei Medical University); Chien-Hsing Lee (Division of
(Departments of Internal Medicine and Medical Research, Endocrinology and Metabolism, Department of Internal
Taipei Veterans General Hospital, Taipei); Ming-Chia Hsieh Medicine, Tri-Service General Hospital, National Defense
(Division of Endocrinology and Metabolism, Department of Medical Center, Taipei); Hung-Yuan Li (Division of Endocri-
Internal Medicine, Changhua Christian Hospital, Changhua, nology and Metabolism, Department of Internal Medicine,
Taiwan); Chih-Cheng Hsu (Institute of Population Health National Taiwan University Hospital, Taipei, Taiwan); Liang-
Sciences, National Health Research Institutes); Li-Chi Yu Lin (Division of Endocrinology & Metabolism, Taipei
Huang (Department of Internal Medicine, Cathay General Veterans General Hospital, Taipei); Shi-Dou Lin (Depart-
Hospital, Taipei); Chien Ning Huang (Department of Endo- ment of Internal Medicine, Changhua Christian Hospital,
crinology and Metabolism, Chung Shan Medical University Changhua); Chia-Hung Lin (Division of Endocrinology and
Hospital, Taichung); Yu-Yao Huang (1. Division of Endocri- Metabolism, Department of Internal Medicine, Chang Gung
nology and Metabolism, Chang Gung Memorial Hospital; 2. Memorial Hospital, Linkou, Taiwan); Chia-Hung Lin
Department of Medical Nutrition Therapy, Chang Gung (Department of Internal Medicine, National Taiwan Uni-
Memorial Hospital); Chi-Sheng Hung (Department of Inter- versity Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan); Kuan-
nal Medicine, National Taiwan University Hospital, Taipei); Yi Lin (Diabetes Education Center, Lukang Christian
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Hospital, Changhua); Hung-Ju Lin (Department of Internal Department of Plastic and Reconstructive Surgery, Chang
Medicine, National Taiwan University Hospital, Taipei); Gung Memorial Hospital, Taoyuan); Neng Chun Yu (Neng
Chih-Hung Lin (Department of Internal Medicine, National Chun Diabetes Clinic); Tse-Ya Yu (Health Management
Taiwan University Hospital, Taipei, Taiwan); Kun-Der Lin Center, Far Eastern Memorial Hospital, New Taipei City).
(Department of Internal Medicine, Kaohsiung Municipal Ta-
Tung Hospital, College of Medicine, Kaohsiung Medical
University); Shih-Yi Lin (1. Center for Geriatrics and References
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Diabetes Excelente 2018

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Diabetes Excelente 2018

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Journal of the Formosan Medical Association xxx (xxxx) xxx

Available online at www.sciencedirect.com

journal homepage: www.jfma-online.com

Executive summary of the DAROC clinical

* Contact information: Wayne Huey-Herng Sheu, President, Dia-

Table 1 Criteria for the diagnosis of diabetes.9

Table 2 Categories of increased risk for diabetes (prediabetes).9

Screening for diabetes in asymptomatic Treatment goals

Table 4 Diagnosis of gestational diabetes mellitus (GDM).12,13

Table 5 Criteria for the screening for diabetes in asymptomatic adults.9,14e18

- The general target of HbA1c is <7%, with individual

Table 6 Treatment goals for non-pregnant adults with diabetes.5,17,19

Table 7 Treatment goals for older adults with diabetes.5

Table 8 Individualized goals for glycemic control.

(e.g. HbA1c < 6.5%) (e.g. HbA1c < 8.5%)

Risk of hypoglycemia or Low High

Duration of diabetes Short (e.g. less than 5 years) Long

Life expectancy Lo n g Short

Associated comorbidities No Severe

Diabetic microvascular and No or mild Severe

Attitude and compliance of Act iv e P assi v e

patients and family

Medical resources and Go od Limited

Table 9 Glycemic goals for women with gestational dia-

Glycemic control for inpatients

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