What the new Standards of Medical Care in Diabetes Mean for You
Each year, the American Diabetes Association (ADA) releases its latest Standards of Medical Care in Diabetes, which provides evidence-based recommendations for diabetes management. It’s the first place health care providers turn to for guidance on how best to treat their patients with diabetes. While the guidelines are geared toward medical professionals, including endocrinologists, primary care doctors, and certified diabetes educators, they also can give people with diabetes a better understanding of their health care needs.
“If patients are aware of what’s new, that allows them to make informed decisions with their health care providers,” says Joshua Neumiller, PharmD, CDE, a certified diabetes educator, associate professor in the college of pharmacy and pharmaceutical sciences at Washington State University, and chair of the committee that reviewed and updated this year’s recommendations.
Keep reading for four important updates in the 2020 guidelines.
Medication costs are a concern for most people with diabetes, especially those who use insulin. The 2020 guidelines note that there are multiple approaches to insulin therapy, including cheaper human insulin options for people who may be unable to afford newer analogs. The guidelines highlight the differences between older and newer therapies, helping health care providers take drug costs into consideration when prescribing medications.
Why It Matters: If you’re struggling to pay for your insulin, these guidelines can help your doctor determine whether a more affordable insulin may work for you.
Medications in the SGLT-2 inhibitor and GLP-1 receptor agonist classes are prescribed to help people with type 2 diabetes meet their A1C targets. (Learn more about these drugs here. [LINK TO MEDICATIONS CHART]) But a number of recent studies show that drugs in those classes have the added benefit of protecting the heart and kidneys. With the 2020 guidelines, the ADA recommends that patients who have or are at risk for cardiovascular or kidney diseases consider adding these medications to their management plan, even if they’re already meeting A1C goals with lifestyle changes or other medications. The updated guidelines also help doctors create individualized treatment plans for cardiovascular disease based on patient-specific factors such as age or A1C.
Why It Matters: Following these new recommendations, your doctor can better take your heart and kidney health into consideration when determining your diabetes therapy. And that can reduce your risk for complications.
With improvements in treatment over the years, people with type 1 diabetes are living longer, healthier lives. A new section in the 2020 guidelines addresses challenges unique to those over the age of 65. For instance, like younger people with type 1 diabetes, older adults with type 1 who are unable to eat due to illness still need to administer basal (long-acting) insulin to avoid diabetic ketoacidosis (DKA), a serious condition that can lead to coma or even death. Because self-management may become difficult as people grow older, the new guidelines also emphasize the importance of caregivers. Long-term care providers may be familiar with type 2 diabetes, but that may not be the case with type 1. The new guidelines recommend educating support staff at rehabilitation centers and long-term care facilities about insulin dosing and diabetes management equipment, such as insulin pumps and continuous glucose monitors (CGMs).
Why It Matters: If you’re over age 65 with type 1 diabetes, now is the time to plan for long-term care. By putting your treatment plan and needs in writing while you’re still able to handle daily self-management, you set yourself (and your family) up for success should you need assistance in the future.
Customization for Kids
While the Standards of Medical Care in Diabetes has long recommended individualized A1C targets for adults with diabetes, kids have received blanket guidance of less than 7.5 percent. But the latest edition recognizes that, just like older patients, children and adolescents have a variety of health considerations that can affect individual glucose targets, including access to diabetes technologies. The new guidance recommends personalized glucose targets for people with diabetes ages 18 and under, ranging from less than 6.5 percent to less than 8 percent, depending on factors such as frequency of glucose monitoring and hypoglycemia (low blood glucose).
Why It Matters: A pediatric endocrinologist now has guidance on how best to treat your child’s individual needs. Be sure to bring up special circumstances that might affect your kid’s A1C target, such as frequent lows or hypoglycemia unawareness (the inability to sense low blood glucose).