ADA, EASD update guidance on managing hyperglycemia

A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes provided updated guidance on social drivers of health, lifestyle changes, and the latest drug studies.

The update to the consensus statement, which was originally published in 2006 and last updated in 2019, was based on a systematic examination of the literature published since 2018. The report was published Sept. 24 by Diabetologia and Sept. 28 by Diabetes Care.

To improve social drivers of health, health systems must ensure equity in delivery of diabetes care, including access to the more expensive drug classes of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists, as well as technologies such as continuous glucose monitoring, according to the consensus statement.

The report also updates its information on sleep, noting that sleep disorders are common in type 2 diabetes and are associated with an increased risk of obesity and impairments in daytime functioning and glucose metabolism. Obstructive sleep apnea affects more than half of patients with type 2 diabetes, and its severity is associated with blood glucose levels, the statement said. By extending sleep duration, it is possible to improve insulin sensitivity and reduce energy intake, but “catch-up” weekend sleep alone is not enough to reverse the impact of insufficient sleep, according to the statement.

The statement puts an increased emphasis on weight management for diabetes. While it was previously seen as a strategy to improve HbA1c and reduce the risk for weight-related complications, weight loss of 5% to 15% should now be a primary target of diabetes management, the consensus authors said, noting that weight loss may have benefits that extend beyond glycemic management to improve risk factors for cardiometabolic disease and quality of life.

The consensus statement also reviews the results of cardiovascular and kidney outcomes trials involving SGLT-2 inhibitors and GLP-1 receptor agonists for cardiorenal protection in high-risk patients and offers practical tips for diabetes management, including the following.

• Consider each person living with diabetes an individual with specific context, risks, and preferences;
• Health care systems should monitor and address inequity in the delivery of evidence-based interventions for type 2 diabetes;
• Assess and address social drivers of health for each individual living with diabetes, particularly in those not achieving goals; and
• Incorporate comorbid conditions when developing and implementing a diabetes management plan.