Standards of Medical Care in Diabetes Updated
What do updates to the Standards of Medical Care in Diabetes mean for you?
The American Diabetes Association’s Standards of Medical Care in Diabetes play a big role in your life. You may not realize it—or even know what they are—but your health care providers do. The comprehensive recommendations, published annually in the Association’s journal Diabetes Care, inform your doctors, dietitians, nurse practitioners, and certified diabetes educators about the latest research, helping them make treatment decisions and give you the best care possible.
The recommendations are reviewed and revised yearly by a committee of experts in diabetes, including endocrinologists, certified diabetes educators, dietitians, researchers, and experts in other medical fields related to diabetes. Read on for some key updates to the 2018 Standards of Medical Care in Diabetes.
As technology advances, so too does our ability to manage diabetes. More health systems are incorporating electronic health records and digital tools into their platforms, and the guidelines now suggest that utilizing such health data can improve diabetes care and may lower health care costs. The Association also endorses the use of diabetes education via digital tools, in addition to in-person visits. See if your insurance will cover sessions with your certified diabetes educator through text, online chats, or web calls.
Previous Standards of Care stated that continuous glucose monitors (CGMs) could help improve glucose management for adults with type 1 diabetes age 25 and above. But, in accordance with recent data, the 2018 guidelines say CGMs have proven to be helpful in this context beginning at age 18.
The Association has also expanded the Standards of Care to include CGM devices that don’t require finger sticks to make treatment decisions as well as a new type of CGM that provides on-demand glucose readings, but without alerts. If you’re interested in trying a CGM, talk with your health care provider about your options (and flip to p. 72 for a list of them).
The A1C test—a measure of blood glucose over the past few months—is used to diagnose and monitor diabetes. Labs can use a variety of ways to measure A1C, and some of those methods yield more-accurate results for specific cases. Evidence has shown, for instance, that age, race, pregnancy, or certain medical conditions or genetic traits that alter the red blood cells may affect A1C results. The Standards now include language to make providers aware of this so they can ensure a lab uses the correct method for determining A1C, or so they can consider using an alternate measure of blood glucose, such as self-monitoring or continuous glucose monitoring. What does this mean for you? If you are in the group that could experience inaccurate results, your doctor will make sure the lab performs the most accurate A1C test for you.
In 2008, the Food and Drug Administration decided that all diabetes medications must undergo cardiovascular outcome trials to make sure they do not increase the risk for heart attack and stroke. Research since then has shown that some diabetes medications actually lower the risk of heart attack, stroke, and death in people with diabetes and heart disease. The Association now incorporates these findings into treatment recommendations for adults with type 2 diabetes and heart disease. It states that after lifestyle management and metformin, the treatment plan should include a diabetes medication shown to improve heart health. It’s a win-win.
Pregnancy and Preeclampsia
Preeclampsia is a serious complication of pregnancy that involves very high blood pressure and potential organ damage. To lower the risk of this condition, the Standards now recommend that women with preexisting type 1 or type 2 diabetes consider daily low-dose aspirin therapy starting at the end of their first trimester. Pregnant? Talk with your doctor about whether aspirin is right for you.
As people with diabetes age, they are more susceptible to cognitive dysfunction, physical disability, and low blood glucose. To address these issues, the 2018 recommendations emphasize the importance of individualized treatment for older adults to lower the risk of hypoglycemia, avoid the overtreatment of diabetes, and simplify complex regimens, if possible. If you are struggling with lows or having trouble remembering to take your insulin or other medications, talk with your doctor about whether an adjustment is needed.
Changes for Children
Most children with diabetes have type 1. But more kids are diagnosed with type 2 diabetes than ever before. The Association has added new recommendations to help detect and treat type 2 diabetes in kids and teens. This means doctors will be better equipped to spot type 2 in kids and provide proper treatment.
Some Things Stay the Same
You may have heard news of new blood pressure targets for adults. It’s true: Some organizations recently changed their definition of high blood pressure to levels greater than or equal to 130/80 mmHg and recommend medications to lower blood pressure. But because these changes were largely based on results from a study that did not include people with diabetes, the American Diabetes Association has concluded that, in general, the definition of high blood pressure for adults with diabetes remains 140/90 mmHg or higher, with a target of less than 140/90 mmHg. Blood pressure targets should be individualized for each person.
The Standards of Medical Care in Diabetes will be updated online whenever new evidence or regulatory changes merit an immediate revision.