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By Jill Murphy, Associate Editor
In the latest update, the ADA makes several key recommendations for diabetes care and management, addressing medications with cardiovascular benefit and treating patients with high blood pressure.
The American Diabetes Association (ADA) recently issued their annualStandards of Care in Diabetesfor 2018. In the latest update, the ADA makes several key recommendations for diabetes care and management, addressing medications with cardiovascular (CV) benefit and treating patients with high blood pressure.
The standards offer comprehensive practice evidence-based recommendations that are based on the most current research findings. Among the updated guidelines are recommendations on the use drugs with potential CV benefit, as well as new recommendations involving diabetes screening, technology, and A1C tests.
Some of the most notable changes are summarized below.
Cardiovascular Disease and Diabetes
New guidelines incorporate the use of diabetes drugs with known cardiovascular benefit. For adults with type 2 diabetes and heart disease, the ADA recommends that, after lifestyle management and metformin, health care providers should include a medication proven to improve heart health.
All hypertensive patients with diabetes are encouraged to monitor their blood pressure at home to help identify potential discrepancies between office vs. home blood pressure, and to improve medication-taking behavior, according to the guidelines.
The new ADA standards also continue with the existing hypertension definition, as opposed to theAmerican College of Cardiology's recently updated blood pressure guidelines. ADA’s guidelines state that most adults with diabetes and hypertension should have a target blood pressure of <140/90 mmHg and that risk-based individualization lowers targets, such as 130/80 mmHg, may be appropriate in some patients.
Youth Diabetes Screening
New recommendations note that testing for prediabetes and type 2 diabetes should be considered in children and adolescents younger than 18 years of age who are overweight or obese, and have 1 or more additional risk factors for diabetes.
Technology and Diabetes =Management
The guideline authors recommend the use of technology-based methods, along with individual and group settings, for the delivery of effective diabetes self-management education and support.
Continuous glucose monitoring (CGM) technology to help improve glycemic control for adults with type 1 diabetes is recommended for use in patients starting at age 18 years old.
A1C Test Considerations
The ADA has updated language and recommendations for A1C tests to emphasize that health care providers should be aware of potential limitations that can affect A1C results, such as age, ethnicity, and pregnancy. Health care providers are also urged to use the correct type of A1C test and to consider alternative diagnostic tests if there is a disagreement between A1C and blood glucose levels.
Diabetes Management in Specific Groups
The recommendations were updated to include the importance of individualizing pharmacotherapy for older adults with diabetes to reduce the risk of hypoglycemia, avoiding overtreatment, and simplifying complex regimens while maintain personalized blood glucose levels.
New to the guidelines is the recommendation for all pregnant women with preexisting type 1 or type 2 diabetes to consider daily low-dose aspirin starting at the end of the first trimester to reduce the risk of pre-eclampsia.
The guidelines also recommend increased awareness and screening for social determinants of health, such as financial ability to afford medications, access to healthy food and food insecurity, and community support.
The ADA will update and revise its online version of the guidelines throughout 2018 with the latest information.
American Diabetes Association.Summary of Revisions: Standards of Medical Care in Diabetes — 2018. Diabetes Care. 2018. 41(Supplement 1): S4-S6.https://doi.org/10.2337/dc18-Srev01
American Diabetes Association Releases 2018 Standards of Medical Care in Diabetes, with Notable New Recommendations for People with Cardiovascular Disease and Diabetes [news release]. ADA’s website.http://www.diabetes.org/newsroom/press-releases/2017/american-diabetes-association-2018-release-standards-of-medical-care-in-diabetes.html. Accessed December 11, 2017.