Changes in the standards of care in diabetes of the American Diabetes Association

Each year the standards of care are reviewed by a committee of experts and updated with the most relevant data for the care of people with diabetes.

The standards of care have been increasing the recommendations in the management of comorbidities and complications in diabetes. Photo: Shutterstock.

One of the most verified graphs throughout the year is the related to the treatment algorithm for people with type 2 diabetes. In the 2021 edition, the first line of the algorithm listed metformin as first-line therapy. In 2022 it is recommended that first-line therapy be adapted to comorbidities, clinical characteristics and possibility of access to drugs and it is pointed out that within this treatment it is very likely that metformin will be included.

The recommendation has been modified taking into consideration the cardiovascular benefit data with some classes, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 analogs in people with diabetes and high cardiovascular risk, and is also close to what has been proposed by other societies, such as the European Society of Cardiology (ESC).

This change allows all pharmacological options are reviewed from the start of therapythat although it is something that should have been done before this recommendation, the persistent idea of ​​metformin, “always first line”, could have limited some people to receive adequate treatment according to their comorbidities.

Now, in this same algorithm, the therapeutic avenues already known for patients with high or very high cardiovascular risk are maintained,those in which you want to avoid hypoglycemia; promote weight loss or prevent weight gain and where access or cost is a highly relevant consideration. The only difference is that the 2022 edition emphasizes the importance of deciding the most effective and appropriate treatment for the patient’s comorbidities, even in these avenues.

Also, it makes a broader exploration of insulin therapy regimens for diabetes patients type 1. This facilitates the reading of the different treatment schemes with insulineither in continuous infusion, with pump or with injections.

Management of obesity in diabetes and cardiovascular disease

The standards of care have been increasing the recommendations in the management of comorbidities and complications in diabetes. Regarding obesity and diabetes, Semaglutide 2.4 mg weekly has been added as an alternative treatment.

Prediabetes/Diabetes Screening

Another important aspect is the change in the age to start screening for prediabetes or diabetes. In the year 2021, the beginning of the scrutiny at 45 years was suggested, while now it is recommended that it be at 35 years. This change aligns with the United States Preventive Services Commission (USPSTF) recommendation, given in mid-2021.

technology in diabetes

One of the strongest recommendations in this area is that of prefer the use of continuous glucose monitoring (real-time or intermittent) in people with diabetes and multiple injections from insulin or in an infusion pump. In addition to this, it has been added that people with insulin basal can also benefit from this technology.

Likewise, it is established that it is necessary to consider the characteristics of each device and the possibility of access for those patients who are candidates. This topic has also expanded the recommendations regarding the information obtained with continuous glucose monitoring, such as time in range, time below range, especially with information for at least 14 days.

In this edition a recommendation is made to prefer the use of pens with prefilled insulin cartridge instead of bottles and syringes, although of course this must be adapted to the cost conditions for each patient.

Vaccination for COVID-19

The 2022 standards add and make clear the recommendation that all eligible adults and children should be vaccinated with the appropriate schedules against COVID-19. This recommendation will vary according to the regimens in each country, but this should be a recommendation for most patients living with diabetes.

These are some of the most relevant changes in this year’s edition of the standards of care, however, there are other modifications that can be reviewed in the changes section found in the first sections of the document.

Source consulted here.

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