The 2014 ICSI Diagnosis and Management of Diabetes Guideline Submission for the ICSI Patient Advisory Council Seal of Approval 1. Demonstrates relevance to and respect for the patient, family and/or caregiver. The risks and benefits to the patient for every recommendation are clearly displayed, including; costs, psychosocial issues, race/ethnicity, quality of life, and safety. Example: Recommendation: A clinician may diagnose a patient with T2DM through the use of an A1C test with a threshold ≥ 6.5%, FPG ≥ 126 mg/dl or a 2-‐h plasma glucose ≥ 200 mg/dl on a 75g OGTT. Additionally if a patient has symptoms of hyperglycemia and casual plasma glucose≥ 200 mg/dl diabetes may be diagnosed. Benefit: A1C testing does not require fasting like other methods of testing, which may increase the likelihood that a patient will undergo testing for T2DM and have appropriate diagnosis and begin treatment. A1C testing also measures chronic glucose exposure over a 2-‐3 month period and is less influenced by internal factors including stress and/or illness than FPG or OGTT. Both OGTT and FPG are not influenced by abnormal red cell turnover conditions and allow for clear guidelines of diagnosis, especially for those who have normal fasting blood sugars. Harm: A1C testing may miss a portion of the population who would be diagnosed with T2DM using FPG or OGTT criteria, including those that have abnormal hemoglobins or condition’s which affect red blood cell turnover. There may also be racial or ethnic differences in the relationship between glycemia and A1C levels, and could result in false negatives or false positives. FPG and OGTT both require fasting, which may reduce screening rates and decrease appropriate diagnosis and management due to convenience. The 2-‐hour OGTT is time consuming in both patient fasting, and administration. Benefit-‐harms Assessment: The general acceptance of all three testing methods and the specific thresholds are well established. Providing a choice of testing methods is likely to increase the likelihood that appropriate patients are tested for diabetes, minimize cost and inconvenience and allow clinicians to individualize test selection based on individual patient characteristics. 1 2. Recommends that early in their care, the patient identify their family and/or caregivers as part of the care team. They are to be informed, included in health care discussions, encouraged to ask questions, involved in decision-‐ making and invited to participate with care, as determined by the patient. The introduction specifically calls out that “the patient, family, and caregivers are key players of the care team”, we go on to then describe how diabetes affects not only the patient in that one moment, but it affects their outlook on life and that their caregivers and family have sometimes as great of impact as the patient themselves. 3. Advocates for a coordinated care team model responsible for effective communication with the patient/family/caregiver, thus preventing care fragmentation and medical error. The guideline focuses on that it is a chronic disease and that it should be managed with other chronic diseases at the same time specifically, hypertension, hyperlipidemia, and obesity. This allows for a primary care team to provide comprehensive care instead of being split out to specialty care providers. 4. Uses literature searches that include one or more of the following: o Patient experiences of the condition, including diagnosis, medication and other treatments, follow-‐up care and quality of life o Information needs and preferences o Participation in decision-‐making about treatment o Overall satisfaction with care received o Patient safety concerns o Care team models o Ethnic and diverse population considerations Literature searches, using Pubmed, dating back to 2005 were utilized and included the phrases: Shared-‐decision making, patient activation, quality of life, patient education, support, satisfaction, and race/ethnicity were all reviewed in collaboration with “Type 2 Diabetes Mellitus. 2 5. Identifies shared decision-‐making opportunities throughout guidelines and materials, where appropriate, and decision aids are included or referenced when available. The diabetes work group focused on patient preference and using appropriate and respectful language through out the process, but identified shared-‐decision making moments in the algorithm with the Shared-‐decision making symbol as focus areas for decision points. (Examples will be brought to the meeting). 6. Encourages use of and/or provides examples or resources for patient and family-‐centered education materials. The guideline has written several recommendations for counseling and providing education to patients. Recommendation Example: A qualified health care professional (which may include: clinician, dietitian, nursing staff and pharmacist) should provide Diabetes Self-‐Management Education and Support (DSME and DSMS) individualized to patients diagnosed with T2DM Benefit: Patients who receive diabetes self management education and support are empowered to manage their care, are more likely to reach goals of care, and may incur less medical costs over time. DSME has been shown to improve diabetes knowledge, improved self-‐care behavior, and improved quality of life. Harm: Patients who do not have access to formal DSME and DSMS may not receive any education due to concerns about qualifications. Benefit-‐harms Assessment: Benefit of providing education and support strongly outweighs any potential harms. 7. Includes one or more patients or community members in workgroups or seeks patient or community member input to review guideline or other materials and provide feedback. Attempts were made to recruit a patient as a member of the work group. The ICSI PAC declined to participate citing that the patient representative on this work group should have personal experience with diabetes or be familiar with a close relative or friend who has the disease. However, this application was submitted to ICSI PAC accompanied with a presentation discussion with the guideline project manager. 3