ADA updates Standards of Care in Diabetes
The updates, which were released by the American Diabetes Association (ADA) in June, cover therapy to delay onset of type 1 diabetes and screening for nonalcoholic fatty liver disease.
The American Diabetes Association (ADA) recently updated its Standards of Care in Diabetes—2023 with changes pertaining to type 1 diabetes and nonalcoholic fatty liver disease (NAFLD).
In Section 2, “Classification and Diagnosis of Diabetes,” the ADA refined the diagnostic criteria to screen for type 1 diabetes in presymptomatic individuals. “Individuals testing positive for autoantibodies may meet criteria for intervention with teplizumab in order to delay development of diabetes,” the ADA said in a June 25 press release.
The ADA updated Section 3, “Prevention or Delay of Type 2 Diabetes and Associated Comorbidities,” to reflect the FDA approval of teplizumab, noting that the drug should be considered to delay the onset of symptomatic diabetes in selected individuals ages 8 years and older with stage 2 type 1 diabetes. “Management should be in a specialized setting with appropriately trained personnel,” the authors wrote.
Accordingly, the recommendations now state that screening for presymptomatic type 1 diabetes may be done by detection of autoantibodies to insulin, glutamic acid decarboxylase, islet antigen 2, or zinc transporter 8. In addition, they note that having multiple confirmed islet autoantibodies is a risk factor for clinical diabetes and that testing for dysglycemia may be used to further forecast near-term risk. “When multiple islet autoantibodies are identified, referral to a specialized center for further evaluation and/or consideration of a clinical trial or approved therapy to potentially delay development of clinical diabetes should be considered,” the recommendations state.
Liver disease affects up to 70% of people with type 2 diabetes. NAFLD, which includes nonalcoholic steatohepatitis, is most common form of liver disease in people with diabetes and can lead to cirrhosis and liver cancer, as well as being associated with increased risk of cardiovascular disease.
The ADA updated Section 4 of the Standards of Care to emphasize the importance of early detection of NAFLD in people with diabetes, as well as appropriate management. “Early detection allows for timely treatment, reducing the chance of developing other serious complications,” the ADA said in a June 25 press release.
The revisions to Section 2, Section 3, and Section 4 are detailed in addenda in Diabetes Care. The complete Standards of Care in Diabetes—2023 are online.