Clinical practice guidelines updated for common chronic conditions

Once a year we review and update as needed the clinical practice guidelines for some of the chronic conditions our members face.

These chronic conditions include diabetes, coronary artery disease (CAD), heart failure, chronic obstructive pulmonary disease (COPD) and asthma. As a result of our review, we are changing our guidelines as follows:

• Diabetes: We are following the America Diabetes Association (ADA) 2016 clinical practice recommendations for diabetes and added the following sections to our guidelines:
  • Screening recommendations:
    • Test all adults beginning at age 45.
    • Test asymptomatic adults at any age who are overweight or obese and have one or more additional risk factors for diabetes.
  • Obesity management:
    • Body mass index (BMI) should be calculated and documented during each patient visit.
    • Diet, physical activity and behavioral therapy designed to achieve 5 percent weight loss should be prescribed for overweight and obese patients to achieve weight loss.
    • Weight loss medications may be effective as adjuncts to diet, physical activity and behavioral counseling for selected patients with Type 2 diabetes and BMI greater or equal to 27.
    • Bariatric surgery may be considered.
  • Cardiovascular disease and risk management:
    • Cardiovascular (CVD) disease is now known as atherosclerotic cardiovascular disease (ACVD).
    • Aspirin therapy as a primary prevention strategy is now considered for most men and women with diabetes age 50 or older who have at least one additional major risk factor.
    • Address antiplatelet use in patients with diabetes and older than 50 years of age with multiple risk factors.

Check out our diabetes guidelines for more detail.

• Coronary Artery Disease (CAD): We are updating the duration of the dual antiplatelet therapy in patients with coronary artery disease to follow the 2016 American College of Cardiology/American Heart Association (ACCA/AHA) guidelines.
  • For patients treated with dual antiplatelet therapy (DAPT), a daily aspirin dose of 81 mg (range, 75 mg – 100 mg) is recommended.

Here are our coronary artery disease guidelines for details.

• Heart failure: We have included the new pharmacological management for heart failure in patients with reduced ejection fraction as recommended by The American College of Cardiology (ACC), the American Heart Association (AHA) and the Heart Failure Society of America (HFSA).
  • The new classes of medications are called angiotensin receptor-neoprilysin inhibitors (ARNI) and a sinoatrial node modular called ivabradine.
    • The ARNI can replace an ACE or ARB and cannot be taken along with an ACE and must not be given to patients with a history of angioedema.
    • Ivabradine is to be given in conjunction with a beta blocker but only to patients who are in a sinus rhythm with a resting heart rate of 70 or more.

View our heart failure guidelines for details.

• Other guidelines: We have not made any changes or any substantive changes to the following guidelines:
  • Asthma (ages 0-4)
  • Asthma (ages 5-11)
  • Asthma (ages 12 and up)
  • Chronic Obstructive Pulmonary Disease (COPD)

If you need to refer to our clinical practice guidelines, please check our provider website or you can call 1-800-390-3522 to request a printed copy.