ADA issues revised standards of care for diabetes

The American Diabetes Association (ADA) has issued revised care standards for diabetes, with changes affecting glycemic targets, blood pressure goals, treatment, and other issues.

“The Standards of Medical Care in Diabetes—2015,” published as a supplement to the January issue of Diabetes Care, includes the following recommendations by the ADA:

• A premeal blood glucose target of 80-130 mg/dL (4.44-7.22 mmol/L), instead of the previous 70-130 mg/dL (3.89-7.22 mmol/L), to reflect new data that compare actual average glucose levels with HbA1c targets;
• A body mass index (BMI) cut point of 23 kg/m², instead of the previous 25 kg/m², for screening overweight or obese Asian-Americans for prediabetes and type 2 diabetes, to reflect evidence that this population is at increased risk for diabetes at lower BMI levels than the general population;
• A diastolic blood pressure goal of 90 mm Hg, instead of the previous 80 mm Hg, for most people with diabetes and hypertension, in line with clinical trial evidence;
• A screening lipid profile upon diagnosis with diabetes, at an initial medical evaluation, and/or at age 40 years, and periodically afterward, in line with 2013 statin treatment and lipid monitoring guidelines from the American College of Cardiology/American Heart Association (ACC/AHA); and
• A foot examination at every visit for all patients with insensate feet, foot deformities, or a history of foot ulcers.

In addition, the revised ADA guidelines say that the decision to treat with statins, and the initial dose, should be determined mainly by risk status rather than LDL cholesterol level, per the 2013 ACC/AHA guidelines. Other revised ADA recommendations address physical activity, the use of e-cigarettes, immunizations, and management of diabetes in pregnancy. The full supplement is available online.