December 28, 2015

ADA 2016 Guidelines – Summary of Revisions

The new American Diabetes Association 2016 guidelines are now posted and the ADA is apparently attempting to be politically correct. The word diabetic will no longer be used to describe patients, but will only be used as an adjective when describing something like diabetic neuropathy. OH -WOW! And, there are more examples of political correctness through out the guidelines.

Strategies for improving care has been revised – including recommendations on tailoring treatment to vulnerable populations with diabetes, including recommendations for those with food insecurity, cognitive dysfunction and/or mental illness, and HIV, and a discussion on disparities related to ethnicity, culture, sex, socioeconomic differences, and disparities.

The support for only diagnosing based on HbA1c has been diminished and includes fasting plasma glucose, 75-gram oral glucose tolerance test, and the A1c test, with no preference to one test. The screening recommendations have now been revised to test all adults beginning at age 45 years, regardless of weight.

Two sections were combined – Initial Evaluation and Diabetes Management Planning and Foundations of Care: Education, Nutrition, Physical Activity, Smoking Cessation, Psychosocial Care, and Immunization from the 2015 Standards were combined into one section for 2016 to reflect the importance of integrating medical evaluation, patient engagement, and ongoing care that highlight the importance of lifestyle and behavioral modification. The nutrition and vaccination recommendations were streamlined to focus on those aspects of care most important and most relevant to people with diabetes.

Many people will be happy to see this - Because of the growing number of older adults with insulin-dependent diabetes, the ADA added the recommendation that people who use continuous glucose monitoring and insulin pumps should have continued access after they turn 65 years of age. Now we will need to push out congressional representatives to pass a bill to force Medicare to do this.

“Atherosclerotic cardiovascular disease” (ASCVD) has replaced the former term “cardiovascular disease” (CVD), as ASCVD is a more specific term.
A new recommendation for pharmacological treatment of older adults was added. To reflect new evidence on ASCVD risk among women, the recommendation to consider aspirin therapy in women aged greater than 60 years has been changed to include women aged 50 years and greater. A recommendation was also added to address antiplatelet use in patients aged less than 50 years with multiple risk factors.

A recommendation was made to reflect new evidence that adding ezetimibe to moderate-intensity statin provides additional cardiovascular benefits for select individuals with diabetes and should be considered. A new table provides efficacy and dose details on high- and moderate-intensity statin therapy.

“Nephropathy” was changed to “diabetic kidney disease” to emphasize that, while nephropathy may stem from a variety of causes, attention is placed on kidney disease that is directly related to diabetes. There are several minor edits to this section. The significant ones, based on new evidence, are as follows:
Diabetic kidney disease: guidance was added on when to refer for renal replacement treatment and when to refer to physicians experienced in the care of diabetic kidney disease.

Diabetic retinopathy: guidance was added on the use of intravitreal anti-VEGF agents for the treatment of center-involved diabetic macular edema, as they were more effective than monotherapy or combination therapy with laser.

The scope of youth section is more comprehensive, capturing the nuances of diabetes care in the pediatric population. This includes new recommendations addressing diabetes self-management education and support, psychosocial issues, and treatment guidelines for type 2 diabetes in youth.

The recommendation to obtain a fasting lipid profile in children starting at age 2 years has been changed to age 10 years, based on a scientific statement on type 1 diabetes and cardiovascular disease from the American Heart Association and the ADA.

There is more and I may cover some of this separately at a later date. Find the Table of Contents here.

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