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ADA incorporates liraglutide approval, CGM targets in revised standards
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The American Diabetes Association added guidance on continuous glucose monitoring and the use of GLP-1 receptor agonists and SGLT2 inhibitors in its latest update to its Standards of Medical Care in Diabetes, according to a press release.
“As ongoing research and data lead to improved treatment recommendations for people with diabetes, the ADA’s Living Standards of Care continue to be revised accordingly, and new updates, such as the time-in-range goals, allow clinicians and researchers in the field to stay abreast of the most accurate guidelines,” William T. Cefalu, MD, chief scientific, medical and mission officer for the ADA, said in the release. “As technology surrounding continuous glucose monitoring evolves, CGM has the opportunity to positively impact the future of diabetes care and research, and establishing standard, official time-in-range recommendations is necessary for the clinical care, regulatory oversight and research efforts related to CGM.”
The update now includes liraglutide (Victoza, Novo Nordisk) as a recommended medication for children aged at least 10 years. Following its recent FDA approval, the medication joins metformin and insulin as the only approved pharmaceutical treatments for pediatric diabetes and, according to the ADA, ends a nearly two-decade drought without a new medication for children with diabetes.
The ADA also added liraglutide to its suggested medications aimed at limiting risks for major adverse cardiovascular events among adults. The association sourced data from the DECLARE-TIMI 58, DELCARE-TIMI 53 and REWIND trials to inform the endorsement of the GLP-1 receptor agonists liraglutide, dulaglutide and semaglutide and the SGLT2 inhibitors empagliflozin and canagliflozin as treatment options to protect adults with type 2 diabetes from major cardiovascular events.
Lastly, the association added a table that outlines recommended metrics for CGM, which it noted can be a useful tool when used in combination with self-monitoring of blood glucose. The revised standards now include a table that defines time-in-range as the percentage of time spent with blood glucose levels between 70 mg/dL and 180 mg/dL as well as an optimal glycemic variability target of no more than 36%. The ADA also advised physicians to utilize an Ambulatory Glucose Profile to “help the patient and the provider interpret the data and use it to guide treatment decisions.”
“The new time-in-range goals and ambulatory glucose profile that are part of the ADA’s Living Standards updates were developed by a panel consisting of individuals with diabetes, physicians and researchers from around the world who are experts in CGM technologies and diabetes research and care,” Richard M. Bergenstal, MD, a consensus panel member and executive director of the International Diabetes Center at Park Nicollet, in Minneapolis, said in the press release. “These guidelines provide the tools for improved consistency for clinicians, researchers, and individuals with diabetes to utilize, and we are pleased that the American Diabetes Association is one of the many professional diabetes organizations around the world to endorse this international consensus report.” – by Phil Neuffer
For more information:
ADA Standards of Medical Care in Diabetes 2019. Available at:
https://care.diabetesjournals.org/content/42/Supplement_1.
Accessed August 1, 2019.
Disclosure: Bergenstal reports no relevant financial disclosures. Cefalu is chief scientific, medical and mission officer for the ADA.