Obesity management, teplizumab guidance among updates in ADA 2024 Standards of Care
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Key takeaways:
- The ADA 2024 Standards of Care includes updates on obesity management and screening for CVD.
- A recommendation discusses the use of teplizumab to delay type 1 diabetes.
New guidance on obesity management and cardiovascular disease screening for people with diabetes are among the updates in the American Diabetes Association’s 2024 Standards of Care.
The ADA published its 2024 Standards of Care in December. The Standards of Care is a comprehensive and evidence-based guideline for managing type 1 diabetes, type 2 diabetes, gestational diabetes and prediabetes based on the latest scientific research and clinical trials. Many of this year’s Standards of Care changes focused on screening for various complications of diabetes, according to Robert Gabbay, MD, PhD, chief scientific and medical officer for the ADA.
“Screening and capturing disease so that we can intervene earlier is really big,” Gabbay said during a press conference. “That includes screening for type 1 diabetes and then thinking about therapeutic options to delay the development of type 1 diabetes.”
One of the biggest areas of emphasis in the 2024 Standards was obesity management for people with diabetes. Language throughout the section on obesity and weight management was adjusted to be more person-centered. Recommendations were changed to encourage providers to incorporate anthropometric measurements beyond BMI, such as waist circumference, waist-to-hip ratio and waist-to-height ratio. New recommendations advise use of GLP-1 receptor agonists or a GIP/GLP-1 dual agonist as the preferred pharmacotherapy for obesity management among people with diabetes and the reevaluation of obesity treatment intensification or deintensification to reach weight goals. Several updates in the metabolic surgery section to discuss the long-term benefits of bariatric surgery.
Two new recommendations put an emphasis on screening for CVD among people with diabetes. The Standards now recommend adults with diabetes be screened for asymptomatic heart failure through the measurement of natriuretic peptide levels.
“The recommendations are to more aggressively screen those at high risk for heart failure with a simple blood test,” Gabbay said. “The recommendations are to screen a broad number of individuals with type 2 diabetes because many are at risk for [heart failure].”
Another recommendation was changed this year to encourage screening for peripheral artery disease. The Standards recommend PAD screening be performed with ankle-brachial index testing among asymptomatic people with diabetes aged 50 years and older with microvascular disease, foot complications or any end-organ damage from diabetes. Additionally, screening should be considered for all people with a diabetes duration of at least 10 years.
A new recommendation on the use of teplizumab was added to the Standards’ section on prevention or delay of diabetes. As Healio previously reported, teplizumab was approved by the FDA in November 2022 to delay the onset of type 1 diabetes for adults and children aged 8 years and older.
“In the recommendations, we talk about screening individuals, particularly first-degree relatives of someone with type 1 diabetes, that we know are at higher risk of developing type 1 [diabetes],” Gabbay said. “The message here is if we can catch individuals early, there are now FDA-approved treatments that can delay the development of type 1 diabetes, and I suspect there will be more in the not-too-distant future.”
Other changes in this year’s Standards of Care include:
- Updates in guidance on the diagnosis and classification of diabetes;
- A greater focus on hypoglycemia prevention and management;
- Emphasis on screening people with diabetes for nonalcoholic fatty liver disease and nonalcoholic steatohepatitis;
- New emphasis on the evaluation and treatment of bone health and more attention to diabetes-specific risk factors for fractures;
- A greater focus on screening and management for people with diabetes and disability;
- Emphases on enabling providers to master diabetes technology, use artificial intelligence for retinal screening and embrace telehealth and digital tools for diabetes self-management education; and
- New information on the possible association between COVID-19 and new-onset type 1 diabetes.
The Standards of Care is available online and will be published as a supplement to the January 2024 issue of Diabetes Care. The online Standards of Care will be updated in real-time if new evidence or regulatory changes merit immediate incorporation. A webcast with continuing education credit and a full slide deck will be available at https://professional.diabetes.org.
Reference:
ADA Standards of Care in Diabetes – 2024. Available at https://diabetesjournals.org/care/issue/47/Supplement_1. Published Dec. 11, 2023. Accessed Dec. 11, 2023.
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