Standards of Medical Care in Diabetes modified for cardiovascular disease

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A new section describes emerging evidence that specific glucose-lowering medications delay the onset and progression of kidney disease.
A new section describes emerging evidence that specific glucose-lowering medications delay the onset and progression of kidney disease.

The American Diabetes Association (ADA) recently updated the Standards of Medical Care in Diabetes to include advances in cardiovascular disease risk management, an updated patient-focused care algorithm, the integration of new technology into diabetes management, and routine screening for type 2 diabetes in high-risk youth, according to a press release published on the ADA website.

Specific changes and updates for the 2018 edition include:

Cardiovascular Disease and Diabetes

  • Adults with type 2 diabetes and heart disease should take medication to improve heart health
  • Most adults with diabetes and hypertension should have a target blood pressure of <140/90 mmHg
  • An algorithm illustrating the recommended antihypertensive treatment approach in adults with diabetes and hypertension
  • Patients with diabetes and hypertension should monitor their blood pressure at home

Screening Youth for Type 2 Diabetes

  • Testing for prediabetes and type 2 diabetes should be considered in individuals age <18 who are overweight or obese and have one or more additional risk factors for diabetes

Health Technology and Diabetes Management

  • Technology-based methods should be included for diabetes self-management education and support
  • Continuous glucose monitoring (CGM) helps improve glycemic control in type 1 diabetes starting at age 18
  • CGM devices that do not require finger-stick confirmation to make treatment decisions and a new type of “flash” CGM that does not have alarms and provides “on demand” glucose readings are described

A1C Test Considerations

  • Alternate diagnostic tests should be considered if there is disagreement between A1C and blood glucose levels

Diabetes Management in Specific Groups

  • Individualized therapy should be considered in older adults with diabetes
  • Pregnant women with preexisting diabetes should consider daily aspirin to decrease the risk of pre-eclampsia

Patient-Centered Care and Acknowledging Cost-of-Care Impact

  • A table summarizing drug-specific and patient factors that may have an impact on diabetes treatment
  • Increased awareness and screening for social determinants of health are recommended

Additional Updates

  • Immunization needs for people with diabetes are clarified
  • Specific glucose-lowering medications may delay the onset and progression of kidney disease
  • A table highlighting the components of a comprehensive medical evaluation has been redesigned.

Reference

  1. American Diabetes Association releases 2018 Standards of Medical Care in Diabetes, with notable new recommendations for people with cardiovascular disease and diabetes [news release]. Arlington, VA: American Diabetes Association. 2017 Dec 8. Accessible at:  www.diabetes.org/newsroom/press-releases/2017/american-diabetes-association-2018-release-standards-of-medical-care-in-diabetes.html.
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