ADA updates its 2019 Standards of Medical Care in Diabetes

Dr KK Aggarwal

The American Diabetes Association (ADA) has updated its 2019 Standards of Medical Care in Diabetes by incorporating recently related published research.

• Based on the results of the REWIND (Researching Cardiovascular Events With a Weekly Incretin in Diabetes) trial, dulaglutide, the once-weekly GLP-1 agonist, is now recognized among other GLP1 receptor agonists that have demonstrated macrovascular benefits in people with type 2 diabetes in section 9 “Pharmacologic Approaches to Glycemic Treatment” and Section 10 “Cardiovascular Disease Risk Management”. The REWIND trial indicated that dulaglutide reduced the risk for nonfatal myocardial infarction, nonfatal stroke and cardiovascular death in adults with type 2 diabetes with and without established cardiovascular disease. This update has also been approved by the American College of Cardiology

• Section 13 “Children and adolescents” now advises liraglutide for some children and adolescents following its approval by the US FDA for use in pediatric patients with type 2 diabetes who are 10 years of age and older, and the Liraglutide in Children and Adolescents with Type 2 Diabetes study, which examined its effects on the youth… “If glycemic targets are no longer met with metformin ± basal insulin, liraglutide therapy should be considered in children 10 years or older, if no history or family history of medullary thyroid carcinoma.”

• The new international consensus report on continuous glucose monitoring (CGM) time-in-range goals has been added in Section 6, Glycemic Targets, and Section 7, Diabetes Technology. A table has been added to help standardize CGM metrics for clinical care and an example of an ambulatory glucose profile has been added to encourage consistency in CGM data report interpretation

These updates have been published online July 31, 2019 in the journal Diabetes Care. 

(Source: ADA News Release, Medscape)

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

Past National President IMA

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