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Overview and Discussion of the 2017 VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care

The 2017 diabetes mellitus guidelines emphasize shared decision making, dietary changes, and HbA1c target range for optimal control of diabetes mellitus.
Federal Practitioner. 2017 October;34(8)s:
October 7, 2018|Federal Practitioner
CDR Mark P. Tschanz, DO, MACM, MC, USN;Sharon A. Watts, DNP, FNP-BC, CDE;Maj Jeffrey A. Colburn, MD, USAF;Paul R. Conlin, MD;Leonard M. Pogach, MD
Author and Disclosure Information

CDR Tschanz is an associate program director at Naval Medical Center San Diego in California. Dr. Watts is the VHA Office of Nursing Services metabolic syndrome & diabetes advisor at Louis Stokes Cleveland VA Medical Center in Ohio. Maj Colburn is a staff endocrinologist at San Antonio Military Medical Center in Texas. Dr. Conlin is chief of the medical service for the VA Boston Healthcare System in Massachusetts. Dr. Pogach is the national director of medicine for the VHA Office of Specialty Care Services.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner , Frontline Medical Communications Inc., the U.S. Government, or any of its agencies.

Acknowledgments
The Diabetes Guideline Working Group wishes to thank several VA and DoD participants: David C. Aron, MD, MS; Mercedes Falciglia, MD; Chester B. Good, MD, MPH; Mary M. Julius, RDN, CDE; Deborah Khachikian, PharmD; Rose Mary Pries, DrPH; Elizabeth Rees Atayde, RN, MSN, FNP, CCM, CPHM; Amy M. Lugo, PharmD, BCPS, BC-ADM, FAPhA; Susan McReynolds, RD, CDE; MAJ Tracy L. Snyder, MS, RD; Evan N. Steil, MD, MBA, MHA; Elaine P. Stuffel, RN, BSN, MHA; COL Gwendolyn H. Thompson, PharmD; Nina A. Watson, MSN, RN, CDE.

We also recognize Eric Rodgers, PhD, RNP-BC, director of the Evidence-Based Practice Program in the VA Office of Quality, Safety and Value; Corinne K.B. Devlin, MSN, RN, FNP-BC, director of the Office of Evidence Based Practice U.S. Army Medical Command; the CPG peer reviewers; and the patients involved in the patient focus group.

Conclusion

The VA/DoD Diabetes Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care strongly recommend SDM in setting management and treatment goals, lifestyle changes that favor a Mediterranean or reduced carbohydrate diet, and targeting HbA1c levels to a range that balances benefits and harms for an individual patient.

This CPG represents a significant step foward in improving the treatment and management of patients with DM in the VA and DoD. This document represents a synthesis of the best available evidence regarding DM care as of March 2016. It is the authors' hope that such recommendations are implemented at the individual practice level. The CPG can help HCPs, but use of such recommendations should be placed in the context of clinical judgment, the patient’s values and preferences, and other available evidence as scientific knowledge and technology advance and treatment patterns evolve.

Application of these CPG recommendations will help VA and DoD clinicians deliver high-quality DM care in a personalized, proactive, and patient-driven manner, that inspires patients to achieve a state of health and well-being that is tailored to their unique characteristics and goals of care.

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