2016 Diabetes Care Standards: What’s New
Updates for you and your health care providers
Each year, the American Diabetes Association reviews and updates the Standards of Medical Care in Diabetes. The publication is the go-to source for health care providers who serve patients with diabetes.
The Association first published its recommendations in 1989. At that time, the document was barely four pages long and featured just 10 references. Evidence-based medicine was in its infancy—most treatment was based on professional opinion rather than research. Now, the Association’s multidisciplinary Professional Practice Committee—made up of experts who volunteer their time—reviews and grades medical evidence to update the guidelines.
The standards are designed to guide, not dictate, care. You and your health care provider can seek a balance between the general guidelines and tailored therapy that fits your situation and needs. Read on for a few highlights and significant changes you’ll find in the 2016 guidelines.
The Association states that people with insulin-dependent diabetes who successfully use insulin pumps and continuous glucose monitors (CGMs) should have continued access at age 65 and beyond. Currently, Medicare requires insulin secretion testing to authorize insulin pumps and does not cover CGMs.
One a Day
Reflecting new evidence on cardiovascular disease risk among women, the age at which to consider daily aspirin therapy dropped from 60 and older to 50 and older. People under age 50 with multiple cardiovascular disease risk factors, such as obesity and high blood pressure, may also benefit from aspirin therapy.
The age at which the Association recommends all adults have a baseline test for type 2 diabetes and future diabetes risk. Testing also is recommended for adults of any age who are overweight or obese (defined as a weight-to-height body mass index of 25 kg/m2 or more, or 23 kg/m2 or more in Asian Americans) and have one or more additional type 2 diabetes risk factors, such as high blood pressure.
Don’t Wait on Weight
For people with prediabetes or type 2 diabetes, health care providers are encouraged to throughly assess a patient’s weight each visit and treat overweight and obesity—in those ready to achieve weight loss—by prescribing diet, physical activity, and behavioral therapy and medication as needed.
For individuals who need but can’t tolerate high-intensity statins or those with recent acute coronary syndrome and with LDL (“bad”) cholesterol at 50 mg/dl or above, ezetimibe (Zetia), which reduces how much cholesterol is absorbed in the small intestine, added to moderate-intensity statin therapy provides additional cardiovascular benefits.
For women of childbearing age with diabetes, the guidelines highlight the importance of discussing with a health care provider options for family planning and effective contraception.
Soon after diagnosis of type 1 diabetes, kids in this age range should have a fasting lipid profile (cholesterol test). Previously, 2 was the suggested age.
6 to 6.5%
The A1C target range recommended for pregnant women with diabetes. An individual woman’s target may be less than 6 percent, if she can safely achieve it without significant hypoglycemia. Some women may need a more relaxed target range of less than 7 percent to minimize the risk of hypoglycemia. Previously, the target for all pregnant women with diabetes was less than 6 percent.
Words With Friends
To emphasize that diabetes does not define people, the document no longer uses the term “diabetic” when referring to individuals. Goodbye “diabetic patient,” hello “patient with diabetes.”
The Eyes Have It
For the treatment of diabetic macular edema that affects central vision, intravitreal anti-VEGF injections work better than laser therapy to slow vision loss and improve vision.
Diabetes and …
Food insecurity, intellectual problems, mental illness, and HIV: The guidelines include tailored treatment suggestions for people with diabetes who also live with these challenges.
To read the complete Standards of Medical Care in Diabetes, visit diabetesjournals.org/site/standards.xhtml.