Diabetes is a condition that affects how your body uses sugar (glucose). In diabetes, insulin production and insulin utilization by the body are negatively affected. Insulin is the hormone that your pancreas releases to help your body to use sugar by turning it into energy. Patients with diabetes do not produce enough insulin, also known as insulin deficiency. Additionally, the body often cannot use insulin as well as it should in people who have diabetes, which is referred to as insulin resistance.
Diabetes Classifications:
- Type 1 diabetes: an autoimmune destruction of the pancreatic beta-cells that produce insulin. Often this leads to complete insulin deficiency where patients produce no insulin.
- Type 2 diabetes: a progressive loss of adequate insulin release from the pancreatic beta-cells that is not related to an autoimmune cause. Type 2 diabetes is often linked to inactivity, eating unhealthy food, and obesity.
- Gestational diabetes: diabetes that is diagnosed in the second or third trimester of pregnancy with no clear diabetes diagnosis prior to the pregnancy.
Every year, the American Diabetes Association® publishes updated guidelines for the care of diabetes patients based on the latest clinical trials, scientific evidence, and new medications that have recently been released on the market. These guideline recommendations are published annually in January in the scientific journal Diabetes Care as a supplemental section titled “Standards of Care in Diabetes.” This supplemental article discusses a wide variety of topics pertinent to diabetes care. Type 1, type 2, and gestational diabetes are all addressed in addition to less common types of diabetes. The supplement discusses recommendations for comprehensive management of diabetes care including diabetes prevention, diagnosis, and treatment. It also includes other important considerations such as management of cholesterol, weight, blood pressure, kidney and heart health for patients with diabetes.
Important 2023 Updates in “Standards of Care in Diabetes”:
Preventative Care:
- Emphasis on more intensive approaches for preventing diabetes in those who are at high risk of progressing to a diabetes diagnosis
- Sleep health recommendations were included for screening for sleep health in people with diabetes and referring to sleep medicine specialists when appropriate
- Updates to vaccine recommendations including COVID-19, COVID-19 bivalent booster, and pneumococcal pneumonia vaccines
- Support for larger weight loss goals, up to 15%, based on the availability and efficacy of certain diabetes medications that can assist with weight loss. More than 10% weight loss may have disease-modifying effects, including remission of diabetes, and possibly improve long-term cardiovascular outcomes
- For patients with gestational diabetes, post-delivery weight loss and breast feeding are supported to reduce the risk of type 2 diabetes
Clinical Targets: - Frail patients or those at higher risk of low blood sugar (hypoglycemia) should aim for a glycemic target of > 50% in range and < 1% below target range
- Blood pressure treatment goals are now < 130/80 mmHg for patients with diabetes
- Patients with diabetes at higher risk for cardiovascular disease should aim to reduce LDL cholesterol by ≥ 50% of baseline and target an LDL cholesterol goal of <70 mg/dL
Medications: - Tirzepatide is a new drug that was approved by the FDA in May 2022. It has a novel mechanism of action as a dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. Tirzepatide was added to the list of glucose-lowering medications that also have potential for weight loss benefits
- The use of sodium–glucose cotransporter 2 inhibitor (SLGT2 inhibitor) drugs was expanded to include use in diabetic patients with either preserved or reduced ejection fraction heart failure
- The drug finerenone was added to the recommended therapies for patients with diabetes and chronic kidney disease with albuminuria (protein in the urine) who are already taking maximally tolerated doses of certain other medications
Read our blog on Diabetes and kidney function
Positive health behaviors, specialized medication plans that account for other medical conditions, and preventative health measures are all important aspects of diabetes care. The latest scientific evidence is assessed every year by experts to provide the annual “Standards of Care in Diabetes” recommendations. Talk to your doctor or pharmacist if you think any of these new recommendations may apply to you for improving your health.
References:
- https://www.cdc.gov/diabetes/basics/diabetes.html
- Summary of Revisions: Standards of Care in Diabetes—2023 | Diabetes Care | American Diabetes Association (diabetesjournals.org). https://diabetesjournals.org/care/article/46/Supplement_1/S5/148048/Summary-of-Revisions-Standards-of-Care-in-Diabetes
