Int J Diabetes Dev Ctries. 2015 Oct;35(Suppl 1):S1-S71
RSSDI Clinical Practice Recommendations for Management of Type 2
Diabetes Mellitus, 2015 Madhu SV, Saboo B, Makkar BM, Reddy GC,
Jana J, Panda JK, Singh S, Setty N, Rao PV, Chawla R, Sahay RK,
Aravind SR, Banerjee S, Bajaj S, Kumar V, Panikar V. Int J Diabetes
Dev Ctries Oct;35(Suppl 1):S1-S71 Diagnosis of Diabetes RSSDI 2015
Recommendations Terminologies Recommended care constitutes
evidence-based care which is cost-effective interventions that
should be made available to all people with diabetes with an aim of
any health-care system to achieve this level of care Limited care
is the lowest level of care that seeks to achieve the major
objectives of diabetes management provided in health-care settings
with very limited resources drugs, personnel, technologies and
procedures Diagnosis of Diabetes: Recommended Care
Any of the following criteria can be used Fasting plasma glucose
(FPG) 126mg/dL*or Oral glucose tolerance test (OGTT) using 75 gms
of anhydrous glucose with FPG 126 mg/dl and/or 2 hour plasma
glucose 200 mg/dL or Glycated hemoglobin (HbA1c) 6.5% **or (not
suggested in Limited Care) Random plasma glucose 200 mg/dl in the
presence of classical diabetes symptoms Asymptomatic individuals
with a single abnormal test should have the test repeated to
confirm the diagnosis unless the result is unequivocally abnormal
*FPG is defined as glucose estimated after no caloric intake for at
least 8-12 hours ** Using a method that is National Glycohemoglobin
Standardization Programme (NGSP) certified. For more on HbA1c &
NGSP, please visitasp Diagnosis of Diabetes: Note
Point of care device for estimation of HbA1c is not recommended for
diagnosis Capillary glucose estimation methods are not recommended
for diagnosis Venous Plasma is used for estimation of Blood glucose
Plasma must be separated soon after collection because the blood
glucose levels drop by 5-8% hourly if whole blood is stored at room
temperature Screening/Early detection of Diabetes RSSDI 2015
Recommendations Screening/early detection of diabetes: Recommended
care
Each health service should decide whether to have a program to
detect people with undiagnosed diabetes This decision should be
based on the prevalence of undiagnosed diabetes and available
support from health-care system/service capable of effectively
treating newly detected cases of diabetes Opportunistic screening
for undiagnosed diabetes and prediabetes is recommended. These
should include: Individuals presenting to health care settings for
unrelated illness Family members of diabetic patients Antenatal
care People over the age of 30 years should be encouraged for
voluntary testing for diabetes) Community screening may be done
wherever feasible Screening/early detection of diabetes:
Recommended care
Detection programs should be usually based on a two-step approach:
Step 1 - Identify high-risk individuals using a risk assessment
questionnaire Indian Diabetes Risk Score (IDRS) is recommended for
Indians. Step 2 - Glycemic measure in high-risk individuals The
Indian Diabetes Risk Score (IDRS) Screening/early detection of
diabetes: Recommended care
Where a random non-FPG level 100 mg/dL to 200 mg/dL is detected,
FPG should be measured, or OGTT should be performed Use of HbA1c as
a sole diagnostic test for screening for diabetes/prediabetes is
not recommended People with screen-positive diabetes need
diagnostic testing to confirm diagnosis while those with
screen-negative to diabetes should be re-tested after 3 years
Paramedical personnel such as nurses or other trained workers be
included as a part of any basic diabetes care team Screening/early
detection of diabetes: Limited care
Detection programs should be opportunistic and limited to high-risk
individuals in very limited settings The principles for screening
are as for Recommended care Diagnosis should be based on FPG or
capillary plasma glucose if only point-of-care testing is available
Using FPG alone for diagnosis has limitations as it is less
sensitive than 2-hour plasma glucose in Indians to diagnose
diabetes Obesity and diabetes RSSDI 2015 Recommendations Obesity
and diabetes: Recommended care
Maintaining healthy lifestyle is recommended for management of
metabolic syndrome. This includes: Moderate calorie restriction (to
achieve a 510 percent loss of body weight in the first year)
Moderate increase in physical activity Change in dietary
composition People with type 2 diabetes should be initiated on
exercise therapy, prescribing a combination of aerobic and muscle
strengthening activities Obesity and diabetes: Recommended
care
Pharmacotherapy for obese type 2 diabetes patients should be
considered in addition to lifestyle changes in those with
BMI>27kg/m2 without co-morbidity, or a BMI >25kg/m2 with
co-morbidity Metformin should be first line drug for all type 2
diabetes patients Lipase inhibitors (Orlistat) may be used for
inducing weight loss GLP-1 analogues (exenatide and liraglutide)
and SGLT-2 inhibitors (Canagliflozin, Dapagliflozin) may be
preferred as add-ons to Metformin in obese T2DM patients Surgical
treatment (Bariatric surgery) is indicated in patients with BMI
>32.5 kg/m2 with co-morbidity, and BMI >37.5 kg/m2 without
co-morbidity Diet therapy RSSDI 2015 Recommendations Diet Therapy:
Recommended care
High-carbohydrate diets with relatively large proportions of
unrefined carbohydrate and fiber such as legumes, unprocessed
vegetables and fruits are recommended. Brown rice is preferred to
polished white rice Protein intake equivalent to at least 15% of
daily total calories is recommended Intake of non-nutritive
artificial sweeteners in moderate amounts may be considered
Combining foods with high and low glycemic indices, such as adding
fiber-rich foods to a meal or snack, improves the glycemic and
lipaemic profiles Diet Therapy: Recommended care Diet in diabetes
patients with established CVD
Total dietary salt intake should be reduced (