ADA guidelines for diabetes
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The 2020 American Diabetes Association (ADA) Standards of Medical Care in Diabetes is an important resource tool used by health professionals in caring for people with diabetes. The document caters to clinicians, patients, researchers, payers, and other interested individuals. In addition, it includes recommendations on general treatment goals and the tools to evaluate the quality of care given.
The Professional Practice Committee (PPC) of the ADA makes it a priority to continuously improve and update the resources used in the Standards of Medical Care in Diabetes. They do this by publishing important and relevant updates such as drug approvals and label changes online.
The recommendations under this position statement ensure that decisions are timely, evidence-based, align with the Chronic Care Model and comply under the appropriate and reliable data metrics.
Diabetes can be classified into the following general categories:
Misdiagnosis among patients with type 1 or patients with type 2 diabetes is common because it is not easily identifiable. This becomes more apparent over time.
According to the ADA, these are the criteria for diagnosis:
DCCT, Diabetes Control and Complications Trial; FPG, fasting plasma glucose; OGTT, oral glucose tolerance test; WHO, World Health Organization; 2-h PG, 2-h plasma glucose.
According to the ADA, patients with prediabetes are recommended at least annual monitoring for the development of type II diabetes. Included in this section are guidelines on lifestyle interventions (such as nutrition and weight loss), pharmacologic interventions, prevention of cardiovascular disease, and diabetes self-management education and support.
Adopting a patient-centered approach to care requires a close working relationship between the patient and clinicians involved in the treatment planning, making medical evaluation successful.
Diabetes self-management education and support (DSMES), medical nutrition therapy (MNT), routine activity for weight loss, smoking cessation counseling when needed, and psycho-social care, are factors which may help reach a person’s target goals to improve his or her health outcomes.
Glycemic management is primarily assessed with the A1C test, which was the measure studied in clinical trials demonstrating the benefits of improved glycemic control. For people with type 2 diabetes, assessment of glycemic control can be done through patient self monitoring of blood glucose (SMBG). Under this position statement include recommendations on A1C testing, glucose assessment, A1C goals, hypoglycemia, and intercurrent illnesses.
This refers to the hardware, devices and software used by people to help manage their condition through either insulin administration (via syringe, pen or pump) or blood glucose monitoring. An example of this is a basal (rapid-acting) insulin which patients with type 2 diabetes commonly used for long acting stabilization of glucose levels during the day and night.
There is strong evidence that obesity management can delay the progression from prediabetes to type 2 diabetes, and is beneficial in the treatment for patients. Diet, physical activity and behavioral activity, pharmacotherapy are some ways to track obesity management. Glucagon-like peptide 1 receptor agonist medications, for example, are approved by the Food and Drug Administration (FDA) for the treatment of obesity.
Insulin therapy is essential among people with Type 1 diabetes. This involves the multiple injections of prandial or basal insulin, or continuous subcutaneous insulin infusion to reduce hypoglycemia risk. A pharmacologic therapy for type 2 diabetes includes combination therapy, which makes maintenance of glycemic targets possible due to the progressive nature of type 2 diabetes.
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality for people with diabetes. ASCVD is defined as coronary heart disease (CHD), cerebrovascular disease, or peripheral arterial disease. Here includes a risk calculator (determining whether you are considered high risk or not), hypertension and blood control, and other risk factors one may have to inform themselves on.
Under this involves information on microvascular complications (such as chronic kidney disease, neuropathy), its evidences for treatment (clinical trial, meta-analysis, randomized controlled studies, etc.) as well as foot care.
Older adults are more at risk for illnesses such as hypertension, heart failure, stroke, chronic kidney disease, etc. Because of this, diabetes management among older adults require regular assessment of medical, psychological, functional, and social domains because there are many complications that come with older age.
Management among children and adolescents cannot be derived from the management of adults due to the difference in epidemiology, pathophysiology, developmental considerations, and response to therapy. Included under this are guidelines for children in terms of glucose lowering, glucose control in patients and diabetes complications.
Diabetes is prevalent among women of reproductive age and women that are pregnant. This section discusses the risk factors of having diabetes in pregnancy and provides recommendations for the following aspects: preconception counseling, preconception care, glycemic targets in pregnancy, management guidelines, pregnancy and drug considerations and postpartum care.
Recommendations under this are on hospital care delivery standards, glycemic targets in hospitalized patients and other components of diabetes care in the hospital. A recommendation under the hospital care delivery standards is:
This section emphasizes the rights for those who have diabetes at all levels. The ADA does this by establishing guidelines which prohibit discrimination.
For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction found in the ADA website https://care.diabetesjournals.org/ or thru https://doi.org/10.2337/dc20-SINT