Preparing for the NASH Epidemic: A Call to Action Kanwal, Fasiha; Shubrook, Jay H.; Younossi, Zobair ...
Gastroenterology,
September 2021, 2021-09-00, 20210901, Volume:
161, Issue:
3
Journal Article, Conference Proceeding
Peer reviewed
Open access
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) are common conditions with a rising burden. Yet there are significant management gaps between clinical guidelines and ...practice in patients with NAFLD and NASH. Further, there is no single global guiding strategy for the management of NAFLD and NASH. The American Gastroenterological Association, in collaboration with 7 professional associations, convened an international conference comprising 32 experts in gastroenterology, hepatology, endocrinology, and primary care providers from the United States, Europe, Asia, and Australia. Conference content was informed by the results of a national NASH Needs Assessment Survey. The participants reviewed and discussed published literature on global burden, screening, risk stratification, diagnosis, and management of individuals with NAFLD, including those with NASH. Participants identified promising approaches for clinical practice and prepared a comprehensive, unified strategy for primary care providers and relevant specialists encompassing the full spectrum of NAFLD/NASH care. They also identified specific high-yield targets for clinical research and called for a unified, international public health response to NAFLD and NASH.
The American Diabetes Association (ADA) updates the Standards of Medical Care in Diabetes annually to provide clinicians, patients, researchers, payers, and other interested parties with ...evidence-based recommendations for the diagnosis and management of diabetes.
To develop the 2020 Standards, the ADA Professional Practice Committee, comprising physicians, adult and pediatric endocrinologists, diabetes educators, registered dietitians, epidemiologists, pharmacists, and public health experts, continuously searched MEDLINE (English language only) from 15 October 2018 through August-September 2019 for pertinent studies, including high-quality trials that addressed pharmacologic management of type 2 diabetes. The committee selected and reviewed the studies, developed the recommendations, and solicited feedback from the larger clinical community.
This synopsis focuses on guidance relating to the pharmacologic treatment of adults with type 2 diabetes. Recommendations address oral and noninsulin injectable therapies, insulin treatment, and combination injectable therapies. Results of recent large trials with cardiovascular and renal outcomes are emphasized.
The American Diabetes Association (ADA) annually updates the Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with ...evidence-based recommendations for the diagnosis and management of patients with diabetes.
For the 2017 Standards, the ADA Professional Practice Committee updated previous MEDLINE searches performed from 1 January 2016 to November 2016 to add, clarify, or revise recommendations based on new evidence. The committee rates the recommendations as A, B, or C, depending on the quality of evidence, or E for expert consensus or clinical experience. The Standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions.
This synopsis focuses on recommendations from the 2017 Standards about pharmacologic approaches to glycemic treatment of type 2 diabetes.
Describe cardio-renal-metabolic (CRM) conditions and their impact on health and patient-centered outcomes. Recognize current gaps in screening, risk factor management, and utilization of ...guideline-directed therapies in patients with CRM conditions. Select appropriate guideline-directed therapies for patients with type 2 diabetes, atherosclerotic cardiovascular disease, heart failure, and/or chronic kidney disease based on current guidelines and clinical evidence. Recognize the importance of multidisciplinary care when managing patients with CRM conditions.
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Find AGA's NASH Clinical Care Pathway App for iOS and Android mobile devices at nash.gastro.org. Scan this QR code to be taken directly to the website.Nonalcoholic fatty liver disease (NAFLD) is ...becoming increasingly common, currently affecting approximately 37% of US adults. NAFLD is most often managed in primary care or endocrine clinics, where clinicians must determine which patients might benefit from secondary care to address hepatic manifestations, comorbid metabolic traits, and cardiovascular risks of the disease. Because NAFLD is largely asymptomatic, and because optimal timing of treatment depends on accurate staging of fibrosis risk, screening at the primary care level is critical, together with consistent, timely, evidence-based, widely accessible, and testable management processes. To achieve these goals, the American Gastroenterological Association assembled a multidisciplinary panel of experts to develop a Clinical Care Pathway providing explicit guidance on the screening, diagnosis, and treatment of NAFLD. This article describes the NAFLD Clinical Care Pathway they developed and provides a rationale supporting proposed steps to assist clinicians in diagnosing and managing NAFLD with clinically significant fibrosis (stage F2–F4) based on the best available evidence. This Pathway is intended to be applicable in any setting where care for patients with NAFLD is provided, including primary care, endocrine, obesity medicine, and gastroenterology practices.
There continues to be debate about eating patterns, glucose, and weight control in people with type 2 diabetes. Recently, very low carbohydrate diets (VLCD) have had success in clinical trials. ...Intermittent fasting or time-restricted eating (TRE) has gained community popularity. In this pilot study, we report follow-up data from a study that randomized participants to VLCD and TRE. A total of 32 participants completed the initial protocol (16 VLCD, 16 TRE). Participants were invited to participate in a 1-year observational follow-up period with phone assessment every 3 months to assess the long-term impacts of the protocol on HbA1c, lipid profile, anthropometrics, and medication regime. Twelve participants (8 VLCD, 5TRE) agreed to follow up. The mean HbA1c in the VLCD was 8.04% at baseline (N=5), mean HbA1c of 8.6% at 6 months (N=3), 8.2% at 9 months (N=1), and 8.63% at 12 months (N=3). For the VLCD group, mean weight was 262lbs at baseline (N=5), 259lbs at 3 months (N=1), 232.5lbs at 6 months (N=2), and 229.4lbs at 12 months (N=5). For the TRE group, the mean A1c was 8.65% at baseline (N=8), 8.5% at 3 months (N=2), 7.8% at 6 months (N=3), 9.4% at 9 months (N=4), and 8.25% at 12 months (N=2). The TRE mean weight was 231.25lbs at baseline (N=8), 237.4lbs at 6 months (N=2), 199.1lbs at 9 months (N=5), and 230.1lbs at 12 months (N=2). While the sample size was small, this study followed participants for 1-year after a 1-month nutritional intervention and illustrated that these dietary plans resulted in different success parameters.
Disclosure
A. Nijjar: None. R. Kiwan: None. T. L. Calinawan: None. J. H. Shubrook: Advisory Panel; AstraZeneca, Eli Lilly and Company, Nevro Corp., Consultant; Abbott Diabetes, Bayer Inc., Novo Nordisk.
The American Diabetes Association (ADA) annually updates its Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with ...evidence-based recommendations for the diagnosis and management of patients with diabetes.
For the 2018 standards, the ADA Professional Practice Committee searched MEDLINE through November 2017 to add, clarify, or revise recommendations on the basis of new evidence. The committee rated the recommendations as A, B, or C depending on the quality of evidence or E for expert consensus or clinical experience. The standards were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions.
This synopsis focuses on guidance relating to cardiovascular disease and risk management in nonpregnant adults with diabetes. Recommendations address diagnosis and treatment of cardiovascular risk factors (hypertension and dyslipidemia), aspirin use, screening for and treatment of coronary heart disease, and lifestyle interventions.
The American Diabetes Association (ADA) annually updates Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based ...recommendations for the diagnosis and management of patients with diabetes.
For the 2017 Standards of Care, the ADA Professional Practice Committee did MEDLINE searches from 1 January 2016 to November 2016 to add, clarify, or revise recommendations on the basis of new evidence. The committee rated the recommendations as A, B, or C, depending on the quality of evidence, or E for expert consensus or clinical experience. The Standards of Care were reviewed and approved by the Executive Committee of the ADA Board of Directors, which includes health care professionals, scientists, and laypersons. Feedback from the larger clinical community informed revisions.
This synopsis focuses on recommendations from the 2017 Standards of Care about monitoring and pharmacologic approaches to glycemic management for type 1 diabetes.
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