Changes to standards of medical care for diabetes

The American Diabetes Association (ADA) publishes a updated version of its Standards of Medical Care in Diabetes each January. The document is updated by the ADA’s Professional Practice Committee (PPC), which reviews recent research and consults with subject matter experts. The goal is to provide healthcare professionals, researchers, insurers, people with diabetes and their loved ones with guidelines on the diagnosis and management of diabetes.

Here is a brief summary of the changes for 2022.

The new guidelines recommend a more individualized approach from the diagnosis of type 2 diabetes, taking into account elements such as the prevention of diabetes complications (such as heart or kidney disease), cost, access to care and individual management needs.

They always recommend metformin as the first medication to prescribe, along with counseling and referrals for lifestyle changes, self-management education, support programs, and medical nutrition therapy. They acknowledged that there are now other drugs that reduce the risk of cardiovascular and kidney complications and that they should be added as soon as possible.

They changed their recommendations on how to manage diabetes-related complications. They advocate a four-pronged approach that includes glucose management, blood pressure management, lipid management, and the use of blood sugar-lowering drugs that have been shown to have heart or kidney benefits, combined with lifestyle modifications and diabetes self-management education and support.

CGMs are now recommended for more diabetics

Although A1C is still considered the primary means of monitoring diabetes control, the ADA now recommends assessing blood sugar management with a 14-day assessment using a CGM. Time in Range and GMI (Glucose Management Indicator – which predicts expected A1C) can be used to better understand glucose highs and lows over time. This information helps healthcare professionals make medical decisions and can also help people with diabetes in their day-to-day diabetes management.

Last year’s ADA guidelines recommended that people taking rapid-acting insulin (such as Novolog, Humalog, Fiasp, and Lyumjev) use a CGM. This year, the ADA expanded that recommendation to also include people who only take long-acting insulin.

The ADA has expanded its recommendations for the use of diabetes technology in all children who use rapid-acting insulin. For children with type 1 diabetes, the ADA also recommends using automated insulin delivery (AID) systems. CGM and AID systems have been shown to improve health outcomes in children, and these insulin delivery technologies allow families to remotely track their children’s health data as well as manage cases of hypoglycemia and hyperglycemia, among others.

The ADA now recommends that adults who do not have symptoms of diabetes be screened for prediabetes and type 2 diabetes starting at age 35. This change was prompted by the US Preventive Services Task Force (USPSTF) lowering his recommended screening age of 45 to 35 in August 2021.

Because COVID-19 has had a disproportionate impact on people with diabetes because they are at higher risk for serious complications from COVID, the ADA recommends that all eligible adults and children with diabetes be fully immunized. Vaccines for COVID-19 were not available when the 2021 guidelines were published.