https://diabetes.acponline.org/archives/2016/01/08/1.htm

ADA revises its Standards of Medical Care in Diabetes

The American Diabetes Association (ADA) recently revised its Standards of Medical Care in Diabetes, making changes to more than a dozen clinical areas and also noting that it will no longer use the word “diabetic” as a noun when referring to people with diabetes.


The American Diabetes Association (ADA) recently revised its Standards of Medical Care in Diabetes, making changes to more than a dozen clinical areas, as well as general recommendations and policies.

In addition to clinical changes for diagnosing diabetes and improving care, the ADA will no longer use the word “diabetic” as a noun to refer to people with diabetes. The Summary of Revisions appeared in a supplement to the January 2016 Diabetes Care.

Specific section changes include the following.

Strategies for Improving Care: This section now includes recommendations on tailoring treatment to vulnerable populations, including those with food insecurity, cognitive dysfunction and/or mental illness, and HIV, as well as disparities related to ethnicity, culture, sex, and socioeconomics.

Classification and Diagnosis of Diabetes: The order and discussion of diagnostic tests (fasting plasma glucose, 2-hour plasma glucose after a 75-g oral glucose tolerance test, and HbA1c criteria) were revised to make it clear that no 1 test is preferred over another. To clarify the relationship between age, body mass index, and risk for type 2 diabetes and prediabetes, the ADA now recommends testing all adults beginning at age 45, regardless of weight. Testing is also recommended for asymptomatic adults of any age who are overweight or obese and who have 1 or more additional risk factors for diabetes.

Glycemic Targets: The ADA added the recommendation that people who use continuous glucose monitoring and insulin pumps should have continued access after they turn 65 years of age.

Obesity Management for Treatment of Type 2 Diabetes: This new section incorporates existing recommendations related to bariatric surgery that had been in another section. It has new recommendations for the comprehensive assessment of weight in diabetes and the treatment of overweight/obesity with behavior modification and pharmacotherapy and includes a new table of currently approved medications for the long-term treatment of obesity.

Cardiovascular Disease and Risk Management: A more specific term, “atherosclerotic cardiovascular disease” (ASCVD), has replaced the former term “cardiovascular disease” (CVD). A new recommendation for pharmacological treatment of older adults was added. To reflect new evidence on ASCVD risk among women, the recommendation to consider aspirin therapy in women older than age 60 has been changed to include women age 50 years and older. A recommendation was also added to address antiplatelet use in patients younger than age 50 years with multiple risk factors. A recommendation was made to reflect new evidence that adding ezetimibe to a moderate-intensity statin provides additional cardiovascular benefits for select patients with diabetes. Efficacy and dose details on high- and moderate-intensity statin therapy are provided in a new table.

Older Adults: The scope of this section is more comprehensive, capturing the nuances of diabetes care in the older adult population. This includes neurocognitive function, hypoglycemia, treatment goals, care in skilled nursing facilities/nursing homes, and end-of-life considerations.

Diabetes Care in the Hospital: This section was revised to focus solely on diabetes care in the hospital setting and covers hospital care delivery standards, more detailed information on glycemic targets and antihyperglycemic agents, standards for special situations, and transitions from the acute care setting. A new table on basal and bolus dosing recommendations for continuous enteral, bolus enteral, and parenteral feedings is also included.