Self-Care Sunday: Standards of Medical Care in Diabetes – 2016 Updates

Each year, the American Diabetes Association (ADA) provides an updated version to their standards of care for health care practitioners.

One of the biggest changes is that the ADA is moving away from the term “diabetic” when describing people with diabetes. Instead, they are recommending that everyone refer to these patients as “individuals with diabetes.” As someone with Type 1 diabetes, it has always been a pet peeve of mine when someone defines themselves or a loved one with the term “diabetic.” There is much more to a person than the disease/condition that they live with! Similarly to someone struggling with an eating disorder, one would prefer not to be called a “bulimic” or “anorexic,” but rather someone with the condition. Diabetes does not define the person and it is relieving to see that the ADA recognizes this.

The original Standards of Care are over 100 pages, but the ADA has put out a summary of revisions that I have outlined below to discuss the specific section changes:

Section 1. Strategies for Improving Care: This section now includes recommendations on tailoring treatment to vulnerable populations — such as those with food insecurities, mental illness, HIV, etc.

Section 2. Classification and Diagnosis of Diabetes: The ADA has revised their screening recommendations to test all adults beginning at age 45 years, regardless of weight/history. Testing is now recommended also for all adults who are considered overweight/obese and who may have one or more additional risk factors of diabetes.

Section 3. Foundations of Care and Comprehensive Medical Evaluation: Two sections from the prior 2015 Standards were combined to create this section, which now encompasses medical evaluation, patient engagement, and ongoing care that highlight the importance of lifestyle changes (nutrition, vaccine recommendations, etc.).

Section 4. Prevention or Delay of Type 2 Diabetes: A recommendation was added to encourage the use of new technology, such as phone apps, text messaging, etc., to help prevent diabetes.

Section 5. Glycemic Targets: Since there is a growing number of older adults with insulin-dependent diabetes (yes!) , the ADA recommended that people who use continuous glucose monitors (CGMs) and insulin pumps have access after age 65. Great news!

Section 6. Obesity Management for Treatment of Type 2 Diabetes: This is a new section this year, highlighting prior recommendations that bariatric surgery could be helpful for DM treatment and also includes a list of currently approved medications used for weight management.

Section 7. Approaches to Glycemic Treatment: This year, bariatric surgery was removed from this section and moved to Section 6. While it may not be the ideal treatment for everyone, some patients have seen a dramatic reduction in their blood sugar.

Section 8. Cardiovascular Disease and Risk Management: Atherosclerotic cardiovascular disease (ASCVD) has replaced CVD (cardiovascular disease) for a more specific term. Additionally, new recommendations for pharmacological treatment was added, including aspirin therapy for women aged >50 years, along with new evidence supporting ezetimibe plus statin provides additional benefits for people with diabetes.

Section 9. Microvascular Complications and Foot Care: Nephropathy has been removed and “diabetic kidney disease” has replaced the term. Guidance was also added on when to refer for renal replacement treatment (dialysis) and also when to refer to a physician specializing in this practice.

Section 10. Older Adults: A more detailed version of the last year’s version that encompasses nuances of diabetes care in the older adult population.

Section 11. Children and Adolescents: this section is also more comprehensive now, which includes a new recommendation that addresses self-management education, psychosocial issues, and treatment guidelines for Type 2 DM in youth. Also, the recommendation to obtain a fasting lipid profile in children starting at 2 years old has been changed to 10 years old due to recent research articles findings.

Section 12. Management of Diabetes in Pregnancy: New recommendations on pregestational diabetes, gestational diabetes and general principles for DM management in pregnancy. A section was added to highlight the importance of family planning/contraception with women with diabetes.  Also, the A1c target for pregnant women with diabetes was changed to 6.0-6.5% (it used to be <6.0%). Glyburide was de-emphasized given the beneficial effects of insulin and metformin.

Section 13. Diabetes Care in the Hospital: This section now addresses hospital care delivery standards, glycemic targets and antihyperglycemic agents, along with transitions from the acute care setting. There is also a new table that outlines basal and bolus dosing recommendations for enteral/parenteral feedings.

Section 14. Diabetes Advocacy: Position statement on care in the school setting was revised and does not include the daycare setting anymore.

Overall, I believe the changes that were made are improvements that will help all practitioners better treat their patients with diabetes. The complete standards of care are here.

Remember, if you or someone you know needs some education on diabetes and eating properly, call Laura, Holly or Lisa for an appointment!

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