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Updated diabetes care guidelines for PCPs stress importance of individualized treatment

Recent updates to the American Diabetes Association’s Standards of Medical Care in Diabetes place an emphasis on individualizing and tailoring care to each patient.

In a commentary, Giulio R. Romeo, MD, and Martin J. Abrahamson, MD, of the Joslin Diabetes Center, highlight three noteworthy sections for nonendocrinologists who care for patients with diabetes.

The revisions include:

• Reducing the BMI cut point in Asian Americans for prediabetes and type 2 diabetes screenings to a BMI of 23 kg/m², rather than 25 kg/m². Researchers note that type 2 diabetes is largely underdiagnosed among Asian populations, and this change may bring more diagnoses, along with prompting updated BMI cut points for other minority groups.

• Targeting hemoglobin A_1C level and treatment plans that reflect each patient’s age, comorbid conditions, life expectancy and lifestyle. The update also recommends customizing drug combinations, keeping in mind a patient’s risk for hypoglycemia, side effects, weight effects and cost.

• Updating systolic and diastolic blood pressure goals to 140 mm Hg and 90 mm Hg, respectively. Lastly, physicians should be cognizant of a patient’s risk for atherosclerotic cardiovascular disease (ASCVD), and consider introducing a more intensified statin treatment for diabetes patients aged 40 years and older, along with monitoring the patient’s adherence to the drugs, regardless of initial low-density lipoprotein cholesterol. The update recommends this plan should account for the risk for or pre-existing ASCVD and discussion of pros and cons with patients.

“The common motif of the 2015 standards is the continued emphasis of individualizing therapeutic decisions based on factors that include ethnicity, overall risk for ASCVD, life expectancy, comorbid conditions, the patient’s preferences and goals, and his or her ability to adhere to treatment regimen. Once more, the patients take the center stage,” Romeo and Abrahamson wrote. – by Casey Hower

Disclosure: The researchers report no relevant financial disclosures.