By Eileen B. Wyner, NP
Bulfinch Medical Group
The American Diabetes Association (ADA) publishes guidelines each January to educate professionals about the best clinical practice for people with diabetes. Beginning in 2018 the ADA will publish updates online as they become available if new evidence or regulatory changes require immediate incorporation. The new recommendations include the areas of cardiovascular health, health technology, screening , and patient centered care. These standards are meant to provide general treatment goals for people with diabetes. They are not meant to replace clinical judgment. I am going to briefly review some of the changes this year. A more detailed explanation of the standards can be found here. Please remember, that these are in no way meant to replace the individual care that you are participating in with your health care team.
Section 1: Improving Care and Promoting Health in Populations
Care for people with diabetes includes assessing for financial resources, access to care, stability of housing situation, ability to access healthy food, and medication use. Additional support for diabetes self-management can come from community health workers, navigators (who help “navigate” health insurance and claims), and lay health coaches who help with self-management.
Section 2: Classification and Diagnosis of Diabetes
Certain medical diagnoses can make A1c test results less accurate. People with conditions that affect red blood cells, such as sickle cell anemia, may get an incorrect result. It is important to use other methods to test for diagnosis and control of diabetes such as fasting and postprandial (after meal) glucose levels.
Section 3: Comprehensive Medical Evaluation and Assessment of Comorbidities
Pancreatitis is now listed as a comorbid condition (another condition a person can have along with diabetes).
Serum testosterone should be checked in men with symptoms of hypogonadism.
Section 4: Lifestyle Management and Section 6: Glycemic Targets
Both sections address the ADA recommendations for using technology to help with diabetes management. This could include teleconference, text messages, or email. The use of continuous glucose monitoring (CGM) for people with Type 1 Diabetes should start at age 18.
Section 8: Pharmacologic Approaches to Glycemic Treatment
Recent study data has shown that all patients newly diagnosed with diabetes should be following strict lifestyle changes and start metformin. People with heart disease should consider additional medication(s) that may reduce cardiovascular events/mortality.
Section 9: Cardiovascular Disease and Risk Management
People with hypertension (high blood pressure) and diabetes should monitor their home readings to help to identify white coat hypertension and to improve medication management and following directions for taking medications. The ADA defines hypertension as blood pressure of 140 or greater /90 or greater.
Lipid management recommendations were changed to group risk in two broad categories: with heart disease and without.
Section 11: Older Adults
It is very important to individualize medical therapy in older adults to achieve the best results without any adverse reactions, such as hypoglycemia. A1c target should be adjusted for age and other medical conditio