New technologies, rapid research and new treatments have helped transform the way diabetes is treated. Since 1989, the American Diabetes Association (ADA) has provided annual updates and provided new guidelines that capture the most current information related to diabetes. For the 2023 standards of care, a conscious effort has been made to use terminology that people with diabetes can easily understand. A recent article in the journal Diabetes Care summarized the latest recommendations for people with diabetes to improve their health and well-being.
Summary of Revisions: Standards of Diabetes Care—2023. Image credit: Stock by Buravleva / Shutterstock
New diabetes guidelines
The summary of the new amendments to the existing guidelines for people with diabetes is as follows:
- Community health workers should be used to manage diabetes and cardiovascular risk factors, especially in health facilities with limited resources. To reach a wider population, digital health, telehealth and telemedicine must be available in more languages. Added more defining terms for non-English speakers to reduce the language barrier in diabetes education.
- A1C testing is recommended for the diagnosis and screening of diabetes at the point of care.
- Prevention or delay of type 2 diabetes and associated comorbidities through regular monitoring of glucose level. Subsequent implementation of prevention measures in people at high risk of developing type 2 diabetes. This approach is known as statin therapy. For example, pioglitazone could be used to reduce the chance of heart attack or stroke in people with a history of insulin resistance and prediabetes. Weight loss, reduced cardiovascular risk and reduced progression of hyperglycemia should be considered in supporting people with diabetes.
- Several changes have been made to immunization, particularly regarding the 2019 coronavirus disease (COVID-19) and pneumococcal pneumonia vaccinations. Added several age-specific recommendations.
- People with non-alcoholic fatty liver disease (NAFLD) and diabetes should be encouraged to lose weight and may be put on pharmacotherapy (glucagon-like peptide 1 (GLP-1) receptor agonists or pioglitazone).
- Improve health outcomes by encouraging behavioral changes. Providing psychosocial support to people with diabetes is essential to standard diabetes care.
- Diabetes self-management education and support (DSMES) guidelines have been updated. Digital platforms and telehealth delivery systems have been recommended for delivering DSMES.
- Appropriate meal patterns and meal planning have been recommended.
- The effectiveness of goal setting to achieve and maintain a glycemic target has been described, which could benefit people at high risk of hypoglycaemia.
- Regular use of diabetes devices is recommended. Based on several findings, continuous glucose monitoring (CGM) has been recommended for diabetic adults treated with basal insulin. In addition, people with diabetes should have uninterrupted access to relevant supplies to minimize disruption to CGM use.
- Current guidelines refer to obesity as a chronic disease. Therefore, small and significant weight loss should be the treatment goals based on individual patient needs. However, more extensive weight loss, ie 10% or more, could have disease-modifying effects, including improvements in long-term cardiovascular outcomes and diabetes remission.
- Adults with type 2 diabetes are at high risk of developing atherosclerotic cardiovascular disease and chronic kidney disease. Therefore, a treatment plan should include strategies that substantially decrease cardiorenal risk.
- Moderate-intensity statin therapy has been recommended for adults over 75 years of age who have diabetes. Age-matched adults with diabetes and atherosclerotic cardiovascular disease are recommended to be treated with high-intensity statins.
- Appropriate clinical interventions are formulated to prevent and reduce the progression of chronic kidney disease. Mineralocorticoid receptor antagonists have been recommended to protect the kidney.
- Older adults with type 1 diabetes may be placed on automated insulin delivery systems or other advanced insulin delivery devices (eg, connected pens). This could reduce the risk of hypoglycemia.
- The new treatment plan is to reduce the risk of hypoglycemia and polypharmacy. Disease burden could be reduced by achieving an individual’s A1C goal.
- Adequate nutritional counseling has been recommended to control diabetes during pregnancy. Nutritional counseling would allow adequate management of carbohydrates and macronutrients through the diet.
Conclusions
Current guidelines emphasize weight loss and healthy eating habits. It also included that people with diabetes should receive appropriate psychosocial support as part of standard diabetes care. CGM devices have been recommended for real-time CGM in children and adults, which has proven to be very beneficial. Since people with diabetes have a higher risk of developing kidney and cardiovascular diseases, appropriate preventive measures should be taken.