ADA updates diabetes standards of care for 2023

The American Diabetes Association (ADA) has changed its recommendations on hypertension cutoffs, use of statins, and treatment of patients with diabetes and chronic kidney disease, among other topics.

The American Diabetes Association recently updated its standards of care in diabetes for 2023.

The latest standards, published on Dec. 12, 2022, include several changes. Among them, the definition of hypertension was revised to match that of the American College of Cardiology and American Heart Association. Hypertension is now defined as a systolic blood pressure greater than or equal to 130 mm Hg or a diastolic blood pressure greater than or equal to 80 mm Hg, based on the average of at least two measurements taken on separate occasions.

Several changes were made to recommendations regarding lipid management. The standards now recommend high-intensity statin therapy in diabetes patients ages 40 to 75 years who are at elevated cardiovascular disease (CVD) risk (e.g., those with one or more CVD risk factors), with the goal of reducing low-density lipoprotein (LDL) cholesterol by at least 50% to a target of less than 70 mg/dL (3.9 mmol/L). Clinicians should also consider adding treatment with ezetimibe or a PCSK9 inhibitor in these patients. Those with diabetes and established CVD should have an LDL target less than 55 mg/dL (3.1 mmol/L) and receive ezetimibe or a PCSK9 inhibitor if that goal is not reached. The standards newly offer recommendations on use of statins in patients with diabetes who are older than age 75 years: If they are currently on statin therapy, it should be continued, and if they are not, it may be reasonable to initiate moderate-intensity statin therapy.

The standards also include changes to treatment recommendations for patients with diabetes and chronic kidney disease. Mineralocorticoid receptor antagonists are now recommended along with other CVD and renal medications rather than as alternatives when other treatments have not been effective. The standards also now say that a sodium-glucose cotransporter-2 (SGLT-2) inhibitor could be initiated at an estimated glomerular filtration rate of 20 mL/min/1.73 m2 or above and a urinary albumin level of 200 mg/g creatinine or above, although they might also be effective in patients with albumin in the range from normal to that cutoff.

Other revisions address weight loss goals, use of diabetes technology, neuropathy, older patients, inpatient care, sleep and activity, and social determinants of health. The full standards of care were published as a supplement to Diabetes Care and include a summary of revisions.