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Preconception Care
Î A1c levels should be as close to normal as possible (<7%) in an
individual patient before conception is attempted. (B)
Î Starting at puberty, preconception counseling should be incorporated
in the routine diabetes clinic visit for all women of child-bearing
potential. (C)
Î Women with diabetes who are contemplating pregnancy should
be evaluated and, if indicated, treated for diabetic retinopathy,
nephropathy, neuropathy, and CVD. (B)
Î Medications used by such women should be evaluated prior to
conception, since drugs commonly used to treat diabetes and
its complications may be contraindicated or not recommended
in pregnancy, including statins, ACE inhibitors, ARBs, and most
noninsulin therapies. (E)
Î Since many pregnancies are unplanned, consider the potential risks
and benefits of medications that are contraindicated in pregnancy in
all women of childbearing potential, and counsel women using such
medications accordingly. (E)
Older Adults
Î Older adults who are functional, cognitively intact, and have significant
life expectancy should receive diabetes care with goals similar to
those developed for younger adults. (E)
Î Glycemic goals for some older adults might reasonably be relaxed,
using individual criteria, but hyperglycemia leading to symptoms or
risk of acute hyperglycemic complications should be avoided in all
patients. (E)
Î Other CV risk factors should be treated in older adults with
consideration of the time frame of benefit and the individual patient.
Treatment of hypertension is indicated in virtually all older adults,
and lipid and aspirin therapy may benefit those with life expectancy
at least equal to the time frame of primary or secondary prevention
trials. (E)
Î Screening for diabetes complications should be individualized in older
adults, but particular attention should be paid to complications that
would lead to functional impairment. (E)
