ADA updates improve care for diabetic patients

September 05, 2023 | by Elizabeth Jones, RD, CDE
Categories: Healthy Driven Life

Diabetes affects millions of people worldwide, and experts are continually looking for ways to make treatment more effective. The American Diabetes Association (ADA) recently published updates to the Standards of Care 2023.

The ADA Standards of Care 2023 offer guidelines for healthcare providers, researchers, insurers and people with diabetes and their loved ones on optimal management of diabetes and its complications.

Since 1989, the Standards of Care in Diabetes are updated annually by a group of diabetes experts to reflect the most recent findings.

It is important for people with diabetes to have access to these up-to-date guidelines, which support their blood sugar management and overall health.

A few of the updates include:

  • Team-based care and access to care. All people with diabetes should receive counseling in healthy lifestyle behaviors and diabetes self-management education and support at least once and may be eligible to receive this annually. The Edward-Elmhurst Health Diabetes Learning Center offers 1:1 visits and classes for diabetes self-management education and support (DSMES) and medical nutrition therapy.

    Additionally, more intensive preventive approaches should be considered for individuals, who are at particularly high risk of progression to diabetes (pharmacotherapy, weight management, cardiovascular risk reduction, minimizing the progression of hyperglycemia). Our Diabetes Learning Center provides a Group Lifestyle Balance Program, based on the CDC research-based Diabetes Prevention Program.

  • Diabetes technology. The use of a continuous glucose monitor (CGM) in people with type 2 diabetes on basal-only insulin therapy, in addition to people on all other types of insulin regimens, is encouraged. When hospitalized, healthcare providers and others in the hospital setting should support continued use of their devices. Ask your doctor how/if acetaminophen, alcohol, vitamin C, hydroxyurea, mannitol or tetracyclin can impact the accuracy of your CGM.

  • Glycemic targets. Patient-centered individualized goals are recommended for those with diabetes. However, a goal of 70% time in range or a hemoglobin A1c of less than 7% is generally desirable.

  • Psychosocial care. The Standards continue and more strongly promote the importance of mental well-being as part of diabetes care and access to mental health resources to support well-being.

  • Diabetes and sleep. Screening for sleep disorders and, if needed, a referral to a sleep specialist or behavioral health specialist is considered part of a comprehensive medical evaluation. Sleep disorders, such as insomnia or obstructive sleep apnea, are risk factors for type 2 diabetes and hyperglycemia.

  • Chronic disease prevention
    • A comprehensive foot evaluation should be done at least annually and for those at high risk,at every visit.
    • Early screening for non-alcoholic fatty liver disease is encouraged.
    • The class of medications, SGLT2 inhibitors, may protect the health of the kidneys and those with decreased kidney function may be eligible for the medication now.
    • Consider the classes of medications, SGLT2 inhibitors or GLP-1 receptor agonists (e.g., Ozempic), for people with atherosclerotic cardiovascular disease (ASCVD) and those with high risk for heart and kidney disease, heart failure and chronic kidney disease.
    • Target LDL cholesterol is less than 70 in people ages 40-75 with diabetes and risk factors for ASCVD and less than 55 in people with diabetes and existing ASCVD.
    • A target blood pressure for those with diabetes was revised and is now 130/80.

  • Weight management. Weight management is considered just as important in prediabetes and diabetes management, as is glucose management. When done safely, weight loss can lead to greater health benefits, such as reducing cardiovascular risk and preventing type 2 diabetes. Benefits of weight loss can be seen beginning with 3-5% body weight loss and progressively increasing with more intensive goals of greater than 15% body weight loss. Emphasis on healthy lifestyle changes, intensive evidence-based structured weight management program (Group Lifestyle Balance Program), medications for weight loss, such GLP-1 receptor agonists (e.g., Ozempic) and metabolic surgery should be considered.

Learn more about diabetes care at Edward-Elmhurst Health.

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