ADA 2017 Standards of Medical Care in Diabetes

Dr K K Aggarwal, National President IMA

The American Diabetes Association (ADA) has released its new Standards of Medical Care in Diabetes for the year 2017. The guidelines have especially focused on psychological health, access to care, expanded and personalized treatment options, and the tracking of hypoglycemia in people with diabetes.

Some salient features of the new Standards of care include:

·         Guidelines on screening adults and youth with diabetes for diabetes distress, depression, anxiety and eating disorders; a list of situations that warrant a referral to a mental health specialist is also included.

·         An expanded list of diabetes comorbidities now includes autoimmune disease, HIV, anxiety disorders, depression, disordered eating behavior and serious mental illness.

·         New lifestyle management guidelines include a physical activity recommendation to interrupt prolonged sedentary behavior every 30 minutes.

·         Sleep patterns should be assessed as part of overall diabetes care because sleep quality may be associated with blood glucose management.

·         The indications for metabolic surgery have been expanded to include patients with inadequately controlled type 2 diabetes who have a BMI as low as 30 kg/m2 (27.5 kg/m2 in Asian Americans).

·         Any of the four classes of blood pressure medications that have shown beneficial cardiovascular outcomes in people with diabetes - ACE inhibitors, angiotensin receptor blockers, thiazide-like diuretics or dihydropyridine calcium channel blockers - may now be used as first-line treatment for hypertension.

·         Anew insulin algorithm included in the guidelines offers more glucose management options for people with type 2 diabetes.

·         The Standards include a new recommendation to consider the GLP-1 receptor agonist liraglutide and the SGLT-2 inhibitor empagliflozin in patients with diabetes and CV disease (history of stroke or heart attack, acute coronary syndromes, angina or peripheral arterial disease) to reduce risk of death.

·         A level of less than 54mg/dl is now defined as denoting serious clinically important hypoglycemia.

·         To help reduce health disparities, the Standards now recommend people with diabetes receive self-management support from lay health coaches, navigators and community health workers.

The Standards are available online on Dec. 15, 2016, and will be published as a supplement to the January 2017 issue of Diabetes Care.

(Source: ADA Press Release, December 15, 2016)