HbA1c conversion table
mmol/mol. Conversion formulas. Old. = 00915 New + 2
A. Units Amounts and Concentrations
Note the abbreviations: 1 mmol = 1 millimole; 2 mmol = 2 millimoles; 5 µmol. = 5 micromoles. Concentrations in molarities are given by expressing the number of
Topic 6: Common Lab Calculations
For example let's say you need 5.0 mmoles of moles to do other calculations (such as calculating molar equivalents or determining the limiting.
Care of Children and Young People with an HbA1C greater than 75
4. 5. HbA1c 58-75 mmols/mol. 5. 6. HbA1c 75 mmol/mol or above. 6. 7. Basic steps comparison chart. 8. 8. Appendix 1: Parents and Young People Education
NICE Guideline Template
5. • intensify drug treatment and. 1. • agree a target and aim for an HbA1c level of 53 mmol/mol (7.0%). [new 2015]. 2. 1.3.4.2 Self-monitoring of blood
Electronic Supplementary Information
4 (1 mmol) KOtBu (0.5 mmol)
4 Calculations Used in Analytical Chemisty
Ex. 4-1. How many moles and millimoles of benzoic acid (M=122.1 g/mol) are Ex 4-5. Describe the preparation of 2.00 L of 0.108 M BaCl2 from BaCl2 · 2H2O.
(Chapter 12) Electrolyte Solutions: Milliequivalents Millimoles
https://uomustansiriyah.edu.iq/media/lectures/4/4_2020_05_08!01_49_17_PM.pdf
HbA1c Conversion Chart. Older DCCT-aligned (%) and newer IFCC
IFCC-standardised values are rounded to the nearest whole number. 5. 6. 7. 8. 9. DCCT (%). IFCC. (mmol/mol).
Glycemic Status and Thromboembolic Risk in Patients With Atrial
thromboembolism among patients with HbA1c=49–58 mmol/mol (hazard ratio 1.49; 95% CI
[PDF] UNITÉS CONVERSIONS EQUIVALENTS & CALCULS DE DOSES
1 oct 2014 · IV m m o l = u n ité d e ré fé re n c e FORMULE DE CONVERSION IONS MONOVALENTS IONS BIVALENTS ION TRIVALENT mmol= milliéquivalent (mEq)
[PDF] Calculs et conversion dunités - Pharmacie des HUG
10 nov 2009 · 4 Le médicament: de la commande à l'administration CAS CLINIQUE 4 --- MILLIMOLES ET MILLIEQUIVALENTS Si la mole (mol) renseigne sur
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de volume V1=16 l et V2=14 l contenant 05 mole d'urée et o 8 moles de glucose respectivement mmol/l Le débit initial est égal a 42pmol/s
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4 la concentration molaire du calcium en mol/L 4 L'azotémie (taux normal d'urée dans le sang) est comprise entre 25 et 75 mmol/L Ce
[PDF] TABLES DES VALEURS EN UNITES CLASSIQUES ET UNITES
0 à 4 µmol/l Sér Calcium Homme 88 à 103 mg/l 002495 220 à 258 mmol/l mmol/l LCR Glucose 05 à 08 g/l 5551 28 à 44 mmol/l
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[PDF] Chapitre 5
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Comment calculer le nombre de mol ?
Il suffit d'appliquer la relation n=m/M pour déterminer le nombre de mole.Comment calculer la mole d'un atome ?
La masse molaire moléculaire est égale à la somme des masses molaires atomiques des éléments chimiques constituant la molécule. L'unité est toujours le gramme par mole, notée g. mol–1. Ainsi, la masse molaire de la molécule d'eau H2O est : M(H2O) = 2 x M(H) + M(O) = 2 x 1,00 + 16,0 = 18,0 g.Comment convertir le mmol en mg ?
(mg/dL x 0,0259 = mmol/L).- Formules de conversion du milliéquivalent :
Ainsi, 1 mEq est représenté par 1 mg d'hydrogène (1 mole) ou 23 mg de Na+, 39 mg de K+, etc.
Internal Clinical Guidelines Team
Draft for consultation
Type 2 diabetes in adults
Type 2 diabetes in adults: management
Clinical Guideline Update (XXX)
Methods, evidence and recommendations
June 2015
Draft for consultation Commissioned by the National Institute for Health and CareExcellence
Type 2 diabetes in adults
Contents
National Institute for Health and Care Excellence, 2015Type 2 diabetes in adults
Disclaimer
Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.Copyright
National Institute for Health and Care Excellence, 2015Type 2 diabetes in adults
Contents
National Institute for Health and Care Excellence, 2015 4Contents
Summary Section ................................................................................................................ 8
1.1 GDG membership and ICG technical team ............................................................ 8
1.1.1 Guideline Development Group 2015 .......................................................... 8
1.1.2 Internal Clinical Guidelines team ................................................................ 9
1.2 Strength of recommendations................................................................................ 9
1.3 Key Priorities for Implementation ......................................................................... 12
1.3.1 Patient education ..................................................................................... 12
1.3.2 Dietary advice .......................................................................................... 12
1.3.3 Blood pressure management ................................................................... 12
1.3.4 Blood glucose management ..................................................................... 12
1.3.5 Drug treatment ......................................................................................... 13
1.4 Algorithm for blood glucose lowering therapy ...................................................... 14
1.5 Recommendations .............................................................................................. 15
1.6 Research recommendations ................................................................................ 26
2 Overview ..................................................................................................................... 30
2.1 Introduction ......................................................................................................... 30
2.2 Prevalence .......................................................................................................... 31
2.3 Health and resource burden ................................................................................ 31
2.4 Reasons for the update ....................................................................................... 31
2.5 Patient-centred care ............................................................................................ 31
3 Methods ...................................................................................................................... 33
3.1 Population ........................................................................................................... 33
3.2 Outcomes ............................................................................................................ 33
3.2.1 Change in blood glucose levels ................................................................ 34
3.2.2 Cardiovascular risk .................................................................................. 34
3.2.3 Diabetes-related complications ................................................................ 34
3.2.4 Adverse events ........................................................................................ 34
3.3 Data extraction .................................................................................................... 35
3.3.1 Time-points .............................................................................................. 35
3.3.2 Conversion of continuous outcome data .................................................. 36
3.3.3 Process .................................................................................................... 36
3.4 Data imputation ................................................................................................... 36
3.4.1 Estimating mean change from baseline ................................................... 36
3.4.2 Estimating person time at risk .................................................................. 37
3.4.3 Approach to missing data ......................................................................... 37
3.5 Crossover trials ................................................................................................... 37
3.6 Evidence synthesis .............................................................................................. 38
3.6.1 Meta-analyses.......................................................................................... 38
Type 2 diabetes in adults
Contents
National Institute for Health and Care Excellence, 2015 53.6.2 Network meta-analyses ............................................................................ 38
3.7 Quality assessment ............................................................................................. 42
3.7.1 GRADE for pairwise meta-analyses ......................................................... 42
3.7.2 Modified GRADE for network meta-analyses .......................................... 43
3.7.3 Modified GRADE for prognostic evidence ................................................ 43
4 Education .................................................................................................................... 45
4.1 Structured education ........................................................................................... 45
4.1.1 Clinical introduction .................................................................................. 45
4.1.2 Methodological introduction and evidence statements ............................. 45
4.1.3 Health economic methodological introduction .......................................... 45
4.1.4 Evidence to recommendations ................................................................. 45
4.1.5 Recommendations and research recommendations ................................ 47
5 Lifestyle and non-pharmacological management .................................................... 49
5.1 Dietary advice ..................................................................................................... 49
5.1.1 Clinical introduction .................................................................................. 49
5.1.2 Methodological introduction...................................................................... 49
5.1.3 Health economic methodological introduction .......................................... 50
5.1.4 Evidence statements ................................................................................ 50
5.1.5 Evidence to recommendations ................................................................. 55
5.1.6 Recommendations and research recommendations ................................ 55
6 Blood pressure therapy ............................................................................................. 57
6.1 Clinical introduction ............................................................................................. 57
6.2 Blood pressure lowering targets and intervention levels ................................... 57
6.2.1 Methodological introduction...................................................................... 57
6.2.2 Health economic methodological introduction .......................................... 58
6.2.3 Evidence statements ................................................................................ 58
6.2.4 Evidence to recommendations ................................................................. 62
6.3 Blood pressure lowering medications .................................................................. 62
6.3.1 Methodological introduction...................................................................... 62
6.3.2 Health economic methodological introduction .......................................... 65
6.3.3 Evidence statements ................................................................................ 65
6.3.4 Health economic evidence statements ..................................................... 78
6.3.5 Evidence to recommendations ................................................................. 78
6.3.6 Recommendations ................................................................................... 80
7 Antiplatelet therapy for primary prevention of cardiovascular disease ................. 82
7.1 Clinical introduction ............................................................................................. 82
7.1.1 Antiplatelet therapy in Clinical Guideline 66 ............................................. 82
7.1.2 Antiplatelet therapy in the update (2015) .................................................. 82
7.1.3 Evidence review ....................................................................................... 82
7.1.4 Evidence statements ................................................................................ 92
Type 2 diabetes in adults
Contents
National Institute for Health and Care Excellence, 2015 67.2 Evidence to recommendations ............................................................................ 93
7.3 Recommendations and research recommendations ............................................ 96
8 Blood glucose management ...................................................................................... 97
8.1 Optimal target values for blood glucose measures .............................................. 97
8.1.1 Clinical introduction .................................................................................. 97
8.1.2 Evidence review ....................................................................................... 97
8.1.3 Evidence to recommendations ............................................................... 120
8.1.4 Recommendations and research recommendations .............................. 122
8.2 Intensive and conventional blood glucose targets .............................................. 124
8.2.1 Clinical introduction ................................................................................ 124
8.2.2 Evidence review ..................................................................................... 124
8.2.3 Evidence to recommendations ............................................................... 135
8.2.4 Recommendations and research recommendations .............................. 137
8.3 Self-monitoring of blood glucose ....................................................................... 138
8.3.1 Clinical introduction ................................................................................ 138
8.3.2 Evidence review ..................................................................................... 138
8.3.3 Evidence to recommendations ............................................................... 159
8.3.4 Recommendations and research recommendations .............................. 164
8.4 Drug treatment to control blood glucose ............................................................ 166
8.4.1 Clinical introduction ................................................................................ 166
8.4.2 Review question ..................................................................................... 168
8.4.3 Health economic methods ...................................................................... 173
8.4.4 Clinical evidence review for initial therapy .............................................. 177
8.4.5 Health economic evidence for initial therapy .......................................... 192
8.4.6 Evidence statements for initial therapy ................................................... 196
8.4.7 Evidence to recommendations for initial therapy .................................... 196
8.4.8 Clinical evidence review for first intensification ....................................... 202
8.4.9 Health economic evidence for first intensification ................................... 219
8.4.10 Evidence statements for first intensification ............................................ 221
8.4.11 Evidence to recommendations for first intensification ............................. 221
8.4.12 Clinical evidence review for second intensification ................................. 226
8.4.13 Health economic evidence for second intensification ............................. 243
8.4.14 Evidence statements for second intensification ...................................... 249
8.4.15 Evidence to recommendations for second intensification ....................... 250
8.4.16 Evidence review for third intensification ................................................. 256
8.4.17 Recommendations ................................................................................. 256
8.4.18 Research recommendations .................................................................. 260
8.5 Long-term serious adverse effects of blood glucose lowering drug treatments .. 263
8.5.1 Clinical introduction ................................................................................ 263
8.5.2 Evidence review ..................................................................................... 263
Type 2 diabetes in adults
Contents
National Institute for Health and Care Excellence, 2015 78.5.3 Evidence statements .............................................................................. 269
8.5.4 Evidence to recommendations ............................................................... 269
8.5.5 Recommendations and research recommendations .............................. 270
9 Managing complications .......................................................................................... 271
9.1 Autonomic neuropathy....................................................................................... 271
9.1.1 Clinical introduction ................................................................................ 271
9.1.2 Methodological introduction.................................................................... 271
9.1.3 Evidence to recommendations ............................................................... 273
9.1.4 Recommendations ................................................................................. 273
9.2 Nerve damage ................................................................................................... 275
9.2.1 Other aspects of autonomic neuropathy ................................................. 275
9.3 Erectile dysfunction ........................................................................................... 277
9.3.1 Clinical introduction ................................................................................ 277
9.3.2 Evidence review ..................................................................................... 277
9.3.3 Evidence to recommendations ............................................................... 287
9.3.4 Recommendations and research recommendations .............................. 290
9.4 Eye damage ...................................................................................................... 292
9.4.1 Methodological introduction.................................................................... 292
9.4.2 Recommendations ................................................................................. 292
10 Reference .................................................................................................................. 294
10.1 Reference for update sections in 2015 (2, 3, 7, 8 and 9.3) ................................ 294
10.2 Reference for sections in CG66 not updated in 2015 (4, 5, 6, 9.1, 9.2 and 9.4) . 318
11 Glossary and Abbreviations .................................................................................... 342
11.1 Glossary ............................................................................................................ 342
11.2 Abbreviations .................................................................................................... 344
12 Appendices AK are in a separate file .................................................................... 345
National Institute for Health and Care Excellence, 2015 8Type 2 diabetes in adults
Summary Section
Update 2015
Summary Section 1
1.1 GDG membership and ICG technical team 2
1.1.1 Guideline Development Group 2015 3
Damien Longson (Guideline Chair) 4
Consultant Liaison Psychiatrist, Manchester Mental Health and Social Care Trust 5Amanda Adler 6
Consultant Diabetologist, Addenbrooke's Hospital, Cambridge University Hospitals NHS 7Foundation Trust 8
Anne Bentley 9
Medicines Optimisation Lead Pharmacist, NHS East Lancashire Primary Care Trust 10Christine Bundy (co-opted expert member) 11
Senior Lecturer in Behavioural Medicine, Institute for Inflammation and Repair, University of 12Manchester 13
Bernard Clarke (co-opted expert member) 14
Honorary Clinical Professor of Cardiology, Manchester Academic Health Science Centre, 15University of Manchester 16
Maria Cowell 17
Community Diabetes Specialist Nurse, Cambridge 18
Indranil Dasgupta (co-opted expert member) 19
Consultant Nephrologist, Heart of England NHS Foundation Trust, Birmingham 20David Ronald Edwards 21
Principal in General Practice, Whitehouse Surgery, Oxfordshire 22Andrew Farmer 23
Professor in General Practice, Department of Primary Care Health Sciences, University of 24Oxford 25
Natasha Jacques 26
Principal Pharmacist in Diabetes, Heart of England NHS Foundation Trust, Birmingham 27Yvonne Johns 28
Patient/carer member 29
Ian Lewin 30
Consultant Diabetologist, North Devon District Hospital, Northern Devon Healthcare NHS 31Trust 32
Natasha Marsland 33
Patient/carer member, Diabetes UK 34
Prunella Neale 35
Practice Nurse, Herschel Medical Centre, Berkshire 36Jonathan Roddick 37
Principal General Practitioner, Woodseats Medical Centre, Sheffield 38 National Institute for Health and Care Excellence, 2015 9Type 2 diabetes in adults
Summary Section
Update 2015
Mohammed Roshan (August 2012 to October 2013) 1
Principal in General Practice, Leicester City and County 2Sailesh Sankar 3
Consultant Diabetologist, University Hospitals Coventry and Warwickshire NHS Trust 4 For a full list of guideline development group declarations of interest, see Appendix A. 51.1.2 Internal Clinical Guidelines team 6
Susan Ellerby 7
Clinical Adviser 8
Nicole Elliott (until June 2014) 9
Associate Director 10
Victoria Gillis (until November 2012) 11
Assistant Technical Analyst 12
Michael Heath (until October 2014) 13
Programme Manager 14
Hugh McGuire (from March 2014) 15
Technical Adviser 16
Stephanie Mills 17
Project Manager 18
Robby Richey (June 2013 to June 2014) 19
Technical Analyst 20
Gabriel Rogers 21
Technical Adviser, Health Economics 22
Abitha Senthinathan (until June 2014) 23
Technical Analyst 24
Susan Spiers (from June 2014) 25
Associate Director 26
Toni Tan (until March 2014) 27
Technical Adviser 28
Sharlene Ting (from June 2014) 29
Technical Analyst 30
Steven Ward 31
Technical Analyst, Health Economics 32
Sheryl Warttig (February 2014 to June 2014) 33
Technical Analyst 34
1.2 Strength of recommendations 35
Some recommendations can be made with more certainty than others. The Guideline 36 Development Group makes a recommendation based on the trade-off between the benefits 37 and harms of an intervention, taking into account the quality of the underpinning evidence. 38 For some interventions, the Guideline Development Group is confident that, given the 39 National Institute for Health and Care Excellence, 2015 10Type 2 diabetes in adults
Summary Section
Update 2015
information it has looked at, most patients would choose the intervention. The wording used 1 in the recommendations in this guideline denotes the certainty with which the 2 recommendation is made (the strength of the recommendation). 3 For all recommendations, NICE expects that there is discussion with the patient about the 4 risks and benefits of the interventions, and their values and preferences. This discussion 5 aims to help them to reach a fully informed decision (se- 6Interventions that must (or must not) be used 7
8 9 recommendation could be extremely serious or potentially life threatening. 10 Interventions that should (or should not) be used 11 the vast majority of patients, an intervention will do more good than harm, and be cost 13 14 confident that an intervention will not be of benefit for most patients. 15Interventions that could be used 16
17 for most patients, and be cost effective, but other options may be similarly cost effective. The 18 choice of intervention, and whether or not to have the intervention at all, is more likely to 19 20 the healthcare professional should spend more time considering and discussing the options 21 with the patient. 22Recommendation wording in guideline updates 23
NICE began using this approach to denote the strength of recommendations in guidelines 24 (January 2009). This does not apply to any recommendations ending [2009] 26 27recommendations labelled [2009]used to denote 28 the strength of the recommendation. 29
Update information 30
This guidance is an update of NICE guideline CG87 (published May 2009) and replaces it. 31 This guidance also updates and replaces NICE technology appraisal guidance 203 and NICE 32 technology appraisal guidance 248. 33 It has not been possible to update all recommendations in this update of the guideline. Areas 34 for review and update were identified and prioritised through the scoping process and 35 stakeholder feedback. Areas that have not been reviewed in this update may be addressed 36 in 2 years' time when NICE next considers updating this guideline. NICE is currently 37 considering setting up a standing update committee for diabetes, which would enable more 38 rapid update of discrete areas of the diabetes guidelines, as and when new and relevant 39 evidence is published. 40 Recommendations are marked as [new 2015], [2015], [2009] or [2009, amended 2015]: 41 National Institute for Health and Care Excellence, 2015 11Type 2 diabetes in adults
Summary Section
Update 2015
[new 2015] indicates that the evidence has been reviewed and the recommendation has 1 been added or updated. 2 [2015] indicates that the evidence has been reviewed but no change has been made to 3 the recommended action. 4 [2009] indicates that the evidence has not been reviewed since 2009. 5 [2009, amended 2015] indicates that the evidence has not been reviewed since 2009, but 6 either changes have been made to the recommendation wording that change the meaning 7 or NICE has made editorial changes to the original wording to clarify the action to be 8 taken.9 National Institute for Health and Care Excellence, 2015 12Type 2 diabetes in adults
Summary Section
Update 2015
Update 2015
1.3 Key Priorities for Implementation 1
1.3.1 Patient education 2
Offer structured education to adults with type 2 diabetes and/or their family members or 3 carers (as appropriate) at and around the time of diagnosis, with annual reinforcement and 4 review. Explain to people and their carers that structured education is an integral part of 5 diabetes care. [2009] 6 Ensure that any structured education programme for adults with type 2 diabetes includes the 7 following components: 8 It is evidence-based, and suits the needs of the person. 9 It has specific aims and learning objectives, and supports the person and their family 10 members and carers in developing attitudes, beliefs, knowledge and skills to self-manage 11 diabetes. 12 It has a structured curriculum that is theory-driven, evidence-based and resource-13 effective, has supporting materials, and is written down. 14 It is delivered by trained educators who have an understanding of educational theory 15 appropriate to the age and needs of the person, and who are trained and competent to 16 deliver the principles and content of the programme. 17 It is quality assured, and reviewed by trained, competent, independent assessors who 18 measure it against criteria that ensure consistency. 19The outcomes are audited regularly. [2015] 20
1.3.2 Dietary advice 21
Integrate dietary advice with a personalised diabetes management plan, including other 22 aspects of lifestyle modification, such as increasing physical activity and losing weight. 23 [2009] 241.3.3 Blood pressure management 25
Add medications if lifestyle advice does not reduce blood pressure to below 140/80 mmHg 26 (below 130/80 mmHg if there is kidney, eye or cerebrovascular damage). [2009] 27 Monitor blood pressure every 12 months, and intensify therapy if the person is already on 28 antihypertensive drug treatment, until the blood pressure is consistently below 140/80 mmHg 29 (below 130/80 mmHg if there is kidney, eye or cerebrovascular damage). [2009] 301.3.4 Blood glucose management 31
1.3.4.1 Targets 32
Involve adults with type 2 diabetes in decisions about their individual HbA1c target. 33 Encourage them to achieve the target and maintain it unless any resulting adverse effects 34(including hypoglycaemia), or their efforts to achieve their target, impair their quality of life. 35
[new 2015] 36 In adults with type 2 diabetes, if HbA1c levels are not adequately controlled by a single drug 37 and rise to 58 mmol/mol (7.5%) or higher: 38 reinforce advice about diet, lifestyle and adherence to drug treatment and 39 National Institute for Health and Care Excellence, 2015 13Type 2 diabetes in adults
Summary Section
Update 2015
intensify drug treatment and 1 agree a target and aim for an HbA1c level of 53 mmol/mol (7.0%). [new 2015] 21.3.4.2 Self-monitoring of blood glucose 3
Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes 4 unless: 5 the person is on insulin or 6 there is evidence of hypoglycaemic episodes or 7 the person is on oral medication that may increase their risk of hypoglycaemia while 8 driving or operating machinery or 9 the person is pregnant, or is planning to become pregnant. For more information, see the 10 NICE guideline on diabetes in pregnancy. [new 2015] 111.3.5 Drug treatment 12
Offer standard-release metformin as the initial drug treatment for adults with type 2 diabetes. 13 [new 2015] 14In adults with type 2 diabetes, if metformin is contraindicated or not tolerated, consider initial 15
drug treatment with: 16 a dipeptidyl peptidase-4 (DPP-4) inhibitor, or 17 pioglitazonea, or 18 repaglinideb, or 19 a sulfonylurea. [new 2015]20a When prescribing pioglitazone, exercise particular caution if the person is at high risk of the adverse effects of
the drug. The MHRA has issued safety alerts on pioglitazone for bladder cancer and cardiac failure. b Repaglinide has a marketing authorisation for use only as monotherapy or in combination with metformin.
Therefore, for adults with type 2 diabetes who cannot take metformin, there is no licensed combination
containing repaglinide that can be offered at first intensification. People should be made aware of this when
initial therapy is being discussed.Type 2 diabetes in adults
Overview
National Institute for Health and Care Excellence, 2015 1 4Update 2015
Update 2015
1.4 Algorithm for blood glucose lowering therapy 1
Insulin-based treatment
When starting insulin, use a structured
programme and continue metformin for people without contraindications or intolerance. Review the continued need for other blood glucose lowering therapies.Offer NPH insulin once or twice daily
according to need.Consider using insulin detemir or glargine if
the person: needs assistance to inject insulin, lifestyle is restricted by recurrent symptomatic hypoglycaemic episodes or would otherwise need twice-daily NPH insulin in combination with oral blood glucose lowering drugs.Consider once or twice-daily pre-mixed
(biphasic) human insulin, particularly ifHbA1c is 75 mmol/mol (9.0%) or higher.
Consider pre-mixed (biphasic) preparations
that include short-acting insulin analogues, rather than pre-mixed (biphasic) preparations that include short-acting human insulin preparations, if: the person prefers injecting insulin immediately before a meal, hypoglycaemia is a problem or blood glucose levels rise markedly after meals.Only offer insulin and a GLP-1 mimetic
4 with specialist care advice and ongoing support.Monitor people on insulin for the need to
change the regimen.Abbreviations:
DPP-4i
Dipeptidyl peptidase-4 inhibitor,
GLP-1Glucagon-like peptide-1,
quotesdbs_dbs33.pdfusesText_39
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