American Diabetes Association announces new evidence-based guidelines and recommendations
A strong recurring message of individualizing patient care is echoed throughout the American Diabetes Association's Standards of Medical Care in Diabetes—2020 (Standards of Care) published today. Based upon the latest scientific diabetes research and clinical trials, the Standards of Care includes new and updated recommendations and guidelines for caring for people with diabetes. This includes simplified figures and tables that more easily guide providers through treatment options and individualized recommendations for treatment of cardiovascular disease based on patients' pre-existing conditions. Special considerations for older adults with type 1 diabetes have also been added to address the treatment of this growing population, as well as revised recommendations and additional supporting evidence for use of rapidly changing diabetes technology.
The 2019 Update to Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) was also published and includes complementary information on the treatment of type 2 diabetes based on important research findings from large cardiovascular outcomes trials published in 2019 and has been incorporated into the Standards of Care—2020.
The Standards of Medical Care in Diabetes—2020 provides the latest in comprehensive, evidence-based recommendations for the diagnosis and treatment of children and adults with type 1, type 2, or gestational diabetes, strategies for the prevention or delay of type 2 diabetes, and therapeutic approaches that can reduce complications, mitigate cardiovascular and renal risk, and improve health outcomes. The Standards of Care is available online today, December 20, 2019, at 2:00 p.m. ET at https:///care.diabetesjournals.org and is published as a supplement to the January 2020 issue of Diabetes Care.
Some notable updates and additions to the Standards of Medical Care in Diabetes—2020 include:
Cardiovascular disease in diabetes
- The recommendations for treatment of cardiovascular disease, which is the leading cause of morbidity and mortality for individuals with diabetes, have now been individualized based on patients' risks, including the presence of atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk factors, diabetic kidney disease, or heart failure (Section 10, page S122–123, Recommendations 10.43A. 10.43B, and 10.43C).
- Use of SGLT2 inhibitors and GLP-1 receptor agonists in patients with or at high risk for cardiovascular disease, kidney disease, or heart failure is now recommended regardless of patients' current A1C or A1C target.
- Figure 9.2 has been simplified to more easily guide providers through intensification of injectable glucose-lowering therapies (Section 9, page S104).
- Oral semaglutide, which was approved by the FDA in September 2019, is now included in the discussion of combination therapies (Section 9, page S105).
- Recommendation 11.3 was modified to provide more detail on the use of SGLT2 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes and diabetic kidney disease (Section 11, page S135, Recommendation 11.3).
- Due to the FDA approval of liraglutide in children 10 years of age or older, there is a new recommendation added to the pharmacologic management of type 2 diabetes information in the "Children and Adolescents" section (Section 13, page S172, Recommendation 13.67).
- Based on the 2019 publication "Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range," new recommendations were added on the use of an ambulatory glucose profile (AGP) report and time in range for assessment of glycemic management (Section 8, page S68, Recommendations 6.4 and 6.5). Additionally, an example of an AGP report was added (Section 6, page S69, Figure 6.1).
- Table 6.1 is updated to reflect a simplified estimated average glucose table (Section 6, page S67) and intranasal glucagon and glucagon solution for subcutaneous injection have been added in the "Hypoglycemia" section due to the medications' recent FDA approval (Section 6, page S73).
Personalizing patient care
- As diabetes management improves, people with type 1 diabetes are living longer; thus, there is a newly added subsection within Section 12 focusing on special considerations for older adults with type 1 diabetes (Section 12, page S158).
- The previously titled "Lifestyle Management" section was changed to "Facilitating Behavior Change and Well-being to Improve Health Outcomes," to better emphasize how effective behavior management and psychological well-being are foundational to achieving treatment goals for people with diabetes (Section 5, pages S48–S65).
- On the basis of a new consensus report, "Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report," the "Lifestyle Interventions" information in Section 3 was updated and a new recommendation was added to recognize that a variety of eating patterns are acceptable for people with prediabetes (Section 3, page S33, Recommendation 3.3). Additionally, the "Nutrition Therapy" information within Section 5 reflects updates based upon the consensus report (Section 5, pages S50–S54).
- Due to the rapidly changing field of diabetes technology, the "Diabetes Technology" section has been reorganized and recommendations within the section have been revised with an emphasis on the fact that there is no "one-size-fits-all" approach to technology use in people with diabetes (Section 7, pages S77–S88).
- Additional information was added to the "Prevention or Delay of Type 2 Diabetes" section regarding the risk reduction certain groups experienced with metformin use, as indicated by the 15-year follow-up data of the Diabetes Prevention Program Outcomes Study (Section 3, pages S34).
Updates to the Standards of Care are established and revised by the ADA's Professional Practice Committee (PPC). The committee is a multidisciplinary team of 16 leading U.S. experts in the field of diabetes care and includes physicians, diabetes educators, registered dietitians, and others whose experience includes adult and pediatric endocrinology, epidemiology, public health, cardiovascular risk management, microvascular complications, preconception and pregnancy care, weight management and diabetes prevention, and use of technology in diabetes management. Two designated representatives of the American College of Cardiology (ACC) reviewed and provided feedback on the "Cardiovascular Disease and Risk Management" section, and this section received endorsement from ACC.
"The American Diabetes Association has developed and provided diabetes care standards, guidelines and related documents since 1989, and its clinical practice recommendations are integral resources for health care professionals," said PPC chair Joshua J. Neumiller, PharmD, CDE, FASCP, Vice Chair and Allen I. White Distinguished Associate Professor of Pharmacotherapy at Washington State University. "As diabetes research and care methods continue to evolve, so do the recommendations and clinical guidelines set forth by the ADA. Through the Standards of Care, the Living Standards and other supplemental tools, the ADA and its Professional Practice Committee strive to ensure care providers, patients, researchers, health plans, and policymakers stay abreast of the most current, research driven components of diabetes care."
The online version of the Standards of Care, or the Living Standards will continue to be annotated in real-time with necessary updates if new evidence or regulatory changes merit immediate incorporation through the living Standards of Care process. The ADA also publishes the abridged Standards of Care yearly for primary care providers in its journal, Clinical Diabetes, and offers a convenient Standards of Care app as well as a Standards of Care pocket chart. Other Standards of Care resources, including a webcast with continuing education credit and a full slide deck, can be found on DiabetesPro.
About Diabetes Care®
Diabetes Care, a monthly journal of the American Diabetes Association (ADA), is the highest-ranked, peer-reviewed journal in the field of diabetes treatment and prevention. Dedicated to increasing knowledge, stimulating research and promoting better health care for people with diabetes, the journal publishes original articles on human studies in clinical care, education and nutrition; epidemiology, health services and psychosocial research; emerging treatments and technologies; and pathophysiology and complications. Diabetes Care also publishes the ADA’s recommendations and statements, clinically relevant review articles, editorials and commentaries. Topics covered are of interest to clinically oriented physicians, researchers, epidemiologists, psychologists, diabetes educators and other health care professionals.
About the American Diabetes Association
Every day more than 4,000 people are newly diagnosed with diabetes in America. Nearly 115 million Americans have diabetes or prediabetes and are striving to manage their lives while living with the disease. The American Diabetes Association (ADA) is the nation’s leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For nearly 80 years the ADA has been driving discovery and research to treat, manage and prevent diabetes, while working relentlessly for a cure. We help people with diabetes thrive by fighting for their rights and developing programs, advocacy and education designed to improve their quality of life. Diabetes has brought us together. What we do next will make us Connected for Life. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (1-800-342-2383). Join the fight with us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).