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

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  • 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.

This article originally appeared on Endocrinology Advisor

Topics:

Cardiovascular Disease Diabetes Diabetes Education Diabetes Management