Thursday, December 20, 2018

ADA 2019 Standards of Medical Care in Diabetes emphasize patient-centered care

The American Diabetes Association (ADA) has published its latest 2019 Standards of Medical Care in Diabetes. There have been several changes and updations from the earlier editions of the guidelines.

For patient-centered glycemic management in type 2 diabetes, a new Goals of Care graphic decision cycle has been included, which details the need for ongoing assessment and shared decision-making to achieve care goals, help reduce therapeutic inertia and improve patient self-management.

The criteria for the diagnosis of diabetes were changed to include two abnormal test results from the same sample i.e., fasting plasma glucose and A1c from same sample.

A patient-centered communication style that uses person-centered and strength-based language and active listening, elicits patient preferences and beliefs, and assesses literacy, numeracy, and potential barriers to care should be used to optimize patient health outcomes and health-related quality of life (QOL).

For older (>65 years) adults with diabetes, optimal nutrition and protein intake is recommended; regular exercise, including aerobic activity and resistance training, are also encouraged in all older adults who can safely engage in such activities.

No one-size-fits-all eating pattern can be recommended for all patients with diabetes. Hence, an individualized medical nutrition therapy program as needed to achieve treatment goals, preferably provided by a registered dietitian, is recommended for all people with type 1 or type 2 diabetes, prediabetes, and gestational diabetes mellitus

A simple and effective approach to glycemia and weight management emphasizing portion control and healthy food choices maybe considered for those with type 2 diabetes who are not taking insulin, who have limited health literacy or numeracy, or who are older and prone to hypoglycemia.

For patients with type 2 diabetes and chronic kidney disease (CKD), use of a sodium–glucose cotransporter 2 inhibitor (SGLT2) or glucagon-like peptide 1 (GLP-1) receptor agonist shown to reduce risk of chronic kidney disease progression, cardiovascular events, or both has been advised. 

Patients who require the additional glucose-lowering efficacy of an injectable medication, a GLP-1 receptor agonist is now recommended as the first choice before insulin for most patients with type 2 diabetes.

Gabapentin is included as a new medication to be considered for the treatment of pain due to diabetic neuropathy.

For the first time, the section on cardiovascular disease and risk management has been endorsed by the American College of Cardiology (ACC). Heart failure has been recognized as a major cause of cardiovascular morbidity and mortality in people with diabetes and the need to consider heart failure when determining optimal diabetes care. The ADA also recommends the use of ACC’s atherosclerotic cardiovascular disease (ASCVD) risk calculator, the ASCVD Risk Estimator Plus for the routine assessment of 10-year ASCVD risk in people with diabetes.

The new recommendations were published online Dec. 17 in Diabetes Care and will be published as a supplement to the January 2019 print issue of the journal.  

(Source: ADA, Diabetes Care)

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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