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ADS Position Statement on Insulin-requiring diabetes and recreational diving
Mervyn Kyi, Barbora Paldus, Natalie Nanayakkara, Michael Bennett, Rebecca Johnson, Catherine Meehan, Peter Colman
In 2015 the Australian Diabetes Society commissioned a working group to review and revise its position statement on scuba diving in persons with diabetes. The working group consisted of endocrinologists with an interest in type 1 diabetes, diving medical specialists, a recreational diver with diabetes and an advocate for people with type 1 diabetes.
A thorough literature review was performed and all available evidence was summarised and a new position statement was drafted. The new position statement was submitted to the ADS Council for approval.
The scope of this document is restricted to recreational (not professional) diving in line with the available evidence. It is also targeted at insulin-requiring (both type 1 and type 2) diabetes, as traditionally this group has been excluded from recreational diving. This document updates the ADS position statement in line with current evidence.
Download the full version of the ADS Insulin-requiring diabetes and recreational diving Position Statement - PDF and Appendicies - PDF (Posted: December, 2016)
ADS launches T2D Treatment Website (A New Blood Glucose Management Algorithm for Type 2 Diabetes)
The launch of the website follows the release of a revised position statement by the ADS entitled, ‘A new blood glucose management algorithm for type 2 diabetes’.
This initiative involved the support of groups including the National Association of Diabetes Centres (NADC), Diabetes Australia (DA), the National Prescribing Service (NPS) and the Royal Australian College of General Practitioners (RACGP).
Please visit http://t2d.diabetessociety.com.au to access the T2D treatment website.
ADS Position Statement on A New Blood Glucose Management Algorithm for Type 2 Diabetes
The blood glucose management algorithm for type 2 diabetes outlines the risks, benefits and costs of available therapies and provides an approach for how to incorporate older and newer agents.
Control of blood glucose levels in people with type 2 diabetes has clear benefits for preventing microvascular complications and potential benefits for reducing macrovascular complications and death.
Treatment needs to be individualised for the person with diabetes.
This should start with selection of the appropriate blood glucose and HbA1c targets, taking into account life expectancy and the wishes of the person with diabetes. A range of recently available therapies have added to our range of options for controlling blood glucose levels but this has made the clinical pathway for managing diabetes more complicated.
To assist with clinical decision making, in 2014 the Australian Diabetes Society council appointed an expert working group to draft a position statement with a focus on the results of recent randomised clinical trials. The original statement was reviewed by the ADS council (September 2014) and then sent to all ADS members for comment before publication in the Medical Journal of Australia (December 2014). In light of new randomised clinical trial evidence the statement and algorithm was updated (December, 2016).
Download the updated (December, 2016) full version of the ADS A New Blood Glucose Management Algorithm for Type 2 Diabetes Position Statement - PDF (Posted: December, 2016)
Australian Obesity Management Algorithm
Obesity is a complex and multi-factorial chronic disease with genetic, environmental, physiological and behavioural determinants that requires long-term care. In 2014-15, 63.4% of Australians aged 18 years and over were above normal weight, with 27.9% being obese. Obesity is associated with a broad range of complications including type 2 diabetes, cardiovascular disease, dyslipidaemia, sleep apnoea, osteoarthritis, and certain types of cancers, which significantly impair quality of life. Obesity and its related complications place a considerable financial burden on Australia. In 2014-15, the direct and indirect costs of obesity were estimated at $ 8.65 billion.
This statement has been developed by a working group with representatives from the Australian Diabetes Society, the Australian and New Zealand Obesity Society and the Obesity Surgery Society of Australian and New Zealand.
The aims of the document are to:
1) Assist general practitioners (GPs) in treatment decisions for non-pregnant adults with obesity
2) Provide a practical clinical tool to guide the implementation of existing guidelines for the treatment of obesity in the primary care setting in Australia.
Download the full version of the Australian Obesity Management Algorithm - PDF (Posted: October, 2016)
Use of "Biosimilar" Insulins for Diabetes Position Statement
This Position Statement represents the collective views of the Australian Diabetes Society, the Australian Diabetes Educators Association and Diabetes Australia.
The Therapeutic Goods Administration (TGA) recently approved the first “biosimilar” insulin product for use in Australia – Basaglar Insulin. A “biosimilar” is a copy of a biological molecule that has already been approved for use and has a demonstrated similarity in physiological characteristics, efficacy and safety.Download the full version of the Use of “biosimilar” Insulins for Diabetes Position Statement - PDF (Posted: October, 2015)
HbA1c for Diagnosis of Diabetes Mellitus
Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus Postion Statement
The use of glycated haemoglobin (HbA1c) for diagnosis of diabetes mellitus has been accepted by Medicare for reimbursement. The position statement "Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus" has also been published in the MJA on 20 July 2015. Click here to view the document in MJA.(https://www.mja.com.au/journal/2015/203/2/guidance-concerning-use-glycated-haemoglobin-hba1c-diagnosis-diabetes-mellitus)
Like any test, the use of HbA1c for the diagnosis of diabetes mellitus has its strengths and weaknesses. It is important for practitioners to be aware of its potential short comings as well as correctly interpreting a positive and a negative result. The aim of this position paper is to provide a succinct summary of how to optimally use the test to diagnose patients. The test represents an important advance and it is hoped that the guidance provided by this position statement will assist health practitioners to use the test effectively.
Download the full version of the 'Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus' Position Statement - PDF (Posted: July, 2015)
Download the Press Release Statement on 'Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus Position Statement' - PDF (Posted: July, 2015)
View and download the new HbA1c Conversion Table
ADS Recommendations for the use of HbA1c for the Diagnosis of Diabetes
HbA1c is now acceptable as a diagnostic test for diabetes. The threshold for diagnosis is at an HbA1c level of 6.5%. The existing glucose criteria for the diagnosis of diabetes remain valid as well.
The criteria for the diagnosis of diabetes are now:
- HbA1c ≥6.5% (48 mmol/mol)
- Fasting glucose ≥7.0 mmol/L
- Random glucose ≥11.1 mmol/L
- On a 75 g oral glucose tolerance test: fasting glucose ≥7.0 mmol/L or 2 hr glucose ≥11.1 mmol/L
In an asymptomatic patient the test should be repeated for confirmation of the result and diagnosis. An abnormal result on 2 different diagnostic tests is also acceptable. For full details of the recommendation of HbA1c for the diagnosis of diabetes, including situations where the HbA1c is unreliable, go to https://www.mja.com.au/journal/2012/197/4/role-hba1c-diagnosis-diabetes-mellitus-australia.
Psychological Care for People with Diabetes: A Position Statement of the American Diabetes Association
Complex environmental, social, behavioral, and emotional factors, known as psychosocial factors, influence living with diabetes, both type 1 and type 2, and achieving satisfactory medical outcomes and psychological well-being. Thus, individuals with diabetes and their families are challenged with complex, multifaceted issues when integrating diabetes care into daily life.
Download the full version of the 'Psychological Care for People with Diabetes: A Position Statement of the American Diabetes Association' - PDF (Posted: December, 2016)
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Guidelines Endorsed by the ADS
Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations
The ADS has recently endorsed international guidelines that recommend metabolic surgery for patients with type 2 diabetes and class III (BMI ≥40 kg/m2) obesity and patients with type 2 diabetes with class II (BMI 35.0–39.9 kg/m2) obesity who have had inadequate glycaemic control with lifestyle and pharmacotherapy.
Download the full version of the 'Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations' Guidelines - PDF (Posted: June, 2016)
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ADS Position Statements & Guidelines
ADS Position Statement on A New Blood Glucose Management Algorithm for Type 2 Diabetes
- Lowering blood glucose levels in people with type 2 diabetes has clear benefits for preventing microvascular complications and potential benefits for reducing macrovascular complications and death.
- Treatment needs to be individualised for each person with diabetes. This should start with selecting appropriate glucose and glycated haemoglobin targets, taking into account life expectancy and the patient's wishes. For most people, early use of glucose-lowering therapies is warranted.
- A range of recently available therapies has added to the options for lowering glucose levels, but this has made the clinical pathway for treating diabetes more complicated.
Download the full version of the ADS A New Blood Glucose Management Algorithm for Type 2 Diabetes Position Statement - PDF (Posted: December, 2014)
The Position Statement was also published in the MJA (Med J Aust 2014; 201 (11): 650-653.). You can read the MJA article online.
ADS Guidelines for Routine Glucose Control In Hospital
The 2012 ADS Guidelines for Routine Glucose Control in Hospital have been developed over the last year, and cover a range of areas including general hospital wards, myocardial infarction, stroke, steroid-induced hyperglycaemia, enteral and parenteral feeding, insulin pump therapy, end of life situations, the optimal means for achieving glucose control, routine measures in hospital, and how to follow-up patients with newly discovered hyperglycaemia. The guidelines were informed by systematic reviews and evidence where there was any; otherwise they were based on consensus.
The Writing Party comprised David Chipps, Shirley Cornelius, Barbara Depczynski, Kristine Heels, David O’Neal, Jennifer Wong, Sophia Zoungas, and Wah Cheung.
Download the ADS Guidelines for Routine Glucose Control in Hospital - PDF
ADS Peri-Operative Diabetes Management Guidelines
These guidelines have been developed by an ADS working group and are primarily intended to provide assistance for those practitioners whose primary focus is not diabetes or who do not have the support of local diabetes expertise in their management of patients with diabetes undergoing surgical procedures.
Download the ADS Peri-operative Diabetes Management Guidelines - PDF
National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults
The Australian Diabetes Society (ADS) and the Australasian Paediatric Endocrine Group (APEG) have completed the National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults and is approved by the NHMRC under section 14A of the National Health and Medical Research Council Act 1992.
Download the National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults - PDF
Download the National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults (Technical Report) - PDF
Download the National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults (Press Release Document) - PDF
(Please Note: Only electronic PDF copies are available)
ADS Position Statement on the Individualisation of HbA1c targets for Adults with Diabetes Mellitus
The Australian Diabetes Society has produced a Position Statement regarding the individualization of HbA1c targets, for adults with diabetes mellitus. This has been published in the Medical Journal of Australia, in the issue of September 21, 2009. A more comprehensive document with further background documentation can also be downloaded here and you can read the MJA article online.
Prediabetes: A Position Statement from the ADS & ADEA
Posted: May, 2007
You can read the MJA article online.
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NHMRC Clinical Practice Diabetes Guidelines
The National Health & Medical Research Council (NHRMC) Clinical Practice Guidelines Portal can be accessed at http://www.clinicalguidelines.gov.au
All publications relating to Diabetes can be viewed and downloaded from the National Health & Medical Research Council (NHMRC) website at: http://www.nhmrc.gov.au/guidelines/publications/subject/Diabetes
- 2009 National Evidence Based Type 2 Diabetes Guidelines
During 2009, five Diabetes Type 2 Guidelines were approved by the Chief Executive Officer (CEO) of NHMRC under Section 14A of the NHMRC Act, namely:
- National Evidence Based Guideline for Diagnosis, Prevention and Management of Chronic Kidney Disease in Type 2 Diabetes
- National Evidence Based Guideline for Case Detection and Diagnosis of Type 2 Diabetes
- National Evidence Based Guideline for Patient Education in Type 2 Diabetes
- National Evidence Based Guideline for Blood Glucose Control in Type 2 Diabetes
- National Evidence Based Guideline for the Primary Prevention of Type 2 Diabetes
These Guidelines comprise a suite of Type 2 Diabetes Guidelines developed under a funding agreement between the Department of Health and Ageing and the Diabetes Australia Guideline Development Consortium. The most recently finalised Guideline the National Evidence Based Guideline for the Primary Prevention of Type 2 Diabetes, was approved by the NHMRC CEO on 10 December 2009.
The five Guidelines in the series, when combined, present a comprehensive set of evidence-based guidelines for the
prevention, diagnosis and management of Type 2 Diabetes.
The five diabetes guidelines above can be viewed or downloaded at:-
http://www.nhmrc.gov.au/publications/synopses/di16to19syn.htm
- Management of Diabetic Retinopathy
The Australian Diabetes Society is delighted to announce that the updated Guidelines for the Management of Diabetic Retinopathy are now available and can be viewed or downloaded from the NHMRC website under publications. The website address is http://www.nhmrc.gov.au/guidelines/publications/di15 . The review, conducted between 2004 and 2007, updates the 1997 guidelines with additional literature from 1996 to the end of August 2007. The ADS would like to thank A/Prof Justin O’Day for his leadership and chairing this working party that included the following members: Dr Ralph Audehm, Dr Daryl Guest, Mr Robert Guthrie, Prof Janet Hiller, A/Prof Jill Keeffe, Mr John Kilmartin, Dr Mark McCoombe, Dr Andrew Magennis, Ms Tracy Merlin, Prof Paul Mitchell, Dr Peter Montgomery, Dr Pat Phillips, and Prof Tien Wong.
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ADS Position Statement Archives
The Australian Diabetes Society has published the following position statements prior to 2001:
- The Lower Limb in People With Diabetes - 2000
- Diabetes and the Eye -1996
(size 295KB - download time approx. 1.2 minutes)
- Life insurance and Diabetes-1990
(size 25KB - download time approx. 6 seconds) - Microalbuminuria in Diabetes - 1993
(size 88KB - download time approx. 21 seconds) - Screening for Non Insulin Dependent Diabetes Mellitus -1996
(size 48KB - download time approx 11 seconds) - Scuba Diving -1994
(size 23KB - download time approx. 6 seconds) - Diabetes and Hypertension - 1996
(size 44KB - download time approx. 11 seconds) - Glycohaemoglobin 1998
(size 24KB - download time approx. 6 seconds) - Diabetes Control and Complications Trial - 1993
(size 17KB - download time approx. 4 seconds) - Implications for Children and Adolescents - 1995
(size 31KB - download time approx. 8 seconds) - Diabetic Dyslipidemias Diabetic Dyslipidemia - 1994
(size 32KB - download time approx 8 seconds) - The Diagnosis of Gestational Diabetes - 1991
(size 18KB - download time approx 5 seconds)
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Statement of Consent
The information contained in the ADS Position Statement & Guidelines section and elsewhere on this website is for general information only. It is designed to be educational and is not intended to be and is not a complete or definitive statement on any area of medical practice or procedure. The Society, its directors and other officers make no express or implied warranties, as to suitability for a particular purpose or otherwise, with respect to any information included on this website. Rapid advances in medicine may cause information contained in this website to become outdated or subject to debate. Visitors to this website who are not medical practitioners qualified in the field should seek further professional advice before any action is taken in relation to the matters described or referred to on this website.