New ADA standards highlight CV outcomes trials, psychosocial health, bariatric surgery

The American Diabetes Association’s updated 2017 Standards of Medical Care in Diabetes includes several new updates that will affect patient care, including new drug recommendations for patients with diabetes and cardiovascular disease, updated bariatric surgery guidelines and a focus on psychosocial health.

The standards, produced annually by the ADA focus on screening, diagnosis and treatment to provide better health outcomes for children, adults and older people with type 1, type 2 or gestational diabetes, and to improve the prevention and delay of type 2 diabetes.

Robert E. Ratner

“This year, the standards include critical, new evidence-based additions — psychosocial care, expanded physical fitness, metabolic surgery and hypoglycemia — all of which can impact effective diabetes care,” Robert E. Ratner, MD, FACP, FACE, chief scientific and medical officer for the ADA, said in a statement. “Together, the new standards and the differentiation report will guide health care providers and patients around the world in a multi-disciplinary approach to provide a comprehensive, individualized diabetes care plan — a plan that accounts for the whole patient and the many variables that can impact their ability to successfully manage diabetes, and thus leads to improved health outcomes.”

The 2017 Standards of Care incorporate several new guidelines issued in 2016 by the ADA, as well as a new recommendation based on results from two large clinical trials for patients with diabetes and CVD. The guideline recommends clinicians consider two specific glucose-lowering medications — the GLP-1 receptor agonist liraglutide and the SGLT-2 inhibitor empagliflozin — in this high-risk population to lower the risk for death. More research is needed to confirm whether the heart benefits are a class effect or if the benefits persist in patients without established CVD.

Other new features include the following:

Guidelines on screening adults and youths with diabetes for diabetes distress, depression, anxiety and eating disorders with a list of situations that warrant referral to a mental health specialist.
An expanded list of diabetes comorbidities to incorporate as part of a comprehensive, patient-centered evaluation, including autoimmune diseases, HIV, anxiety disorders, depression and serious mental illness.
New physical activity recommendations that call for interrupting prolonged sedentary behavior every 30 minutes.
Bariatric surgery guidelines now recommend that patients with inadequately controlled type 2 diabetes and a BMI of 30 kg/m² or greater (27.5 kg/m² for Asian Americans) should be considered as candidates for bariatric surgery.
For patients with diabetes and hypertension, ACE inhibitors, angiotensin receptor blockers, thiazide-like diuretics or dihydropyridine calcium channel blockers are all options for first-line therapy for hypertension.
Updated guidelines on hypoglycemia indicating that a level of less than 54mg/dL be defined as denoting “serious clinically important hypoglycemia,” regardless of whether that level is associated with symptoms, and that incidences of hypoglycemia within that range be reported during clinical trials and in clinical practice.

The standards also include the findings of a new report on diabetes staging, titled “Differentiation of Diabetes by Pathophysiology, Natural History and Prognosis.” That report and the revised standards were published online simultaneously in Diabetes Care. –by Regina Schaffer

For more information:

ADA 2017 Standards of Medical Care. Available at: http://care.diabetesjournals.org/content/40/Supplement_1/S4.