The American Diabetes Association has released new standards of care to reflect changes in technology, improved medications, and a greater understanding of the social factors that contribute to disease and diabetes management.
The standards are updated annually, but this year includes approximately 100 new or revised recommendations affecting all types of diabetes.
Guidelines are provided to doctors via apps and online. Last year, he was accessed more than 4 million times worldwide, said Dr. Robert Gabbay, Chief Scientific and Medical Officer of the Diabetes Association.
In addition to changing standards for weight management, blood pressure and cholesterol management, the revision is also intended to address racial disparities in care, said Nuha El, chair of the association’s Professional Practices Committee, which created the revision. Dr. Said said. He is a physician at the Joslin Diabetes Center in Boston and a lecturer at Harvard Medical School.
Racial differences in diabetes have no biological basis, and the guidelines are designed to “help people see the big disparities in care and outcomes.”
New tools, especially more effective weight-loss drugs, should give diabetics more control over their weight, Gabbay said. Losing 15% of your body weight, as opposed to the previously recommended 5%, should provide more health benefits, he said.
“We now have better tools to achieve these goals and are making them a reality,” says Gabbay.
Diet and exercise guidelines, such as eating a balanced diet and cutting back on processed foods and added sugars, haven’t changed.
Prevention of heart disease and kidney disease
Diabetes is the leading cause of heart disease, and heart disease is the leading cause of death for people with diabetes, Gabbay said.
In line with the American College of Cardiology, the new guidelines include a low goal of blood pressure above 80 and below 130. For the bad kind of LDL cholesterol, new guidelines call for a reading of 70 in people without heart disease. from 100, and 55 instead of 70 for people with established heart disease.
Dr. Gavey says statins are very good at lowering cholesterol levels, and other drugs can effectively lower blood pressure to meet these goals.
“There are many studies showing that lower goals yield better results for people with diabetes,” he said.
The guidelines also call for more aggressive treatment to prevent progression of chronic kidney disease.
“Diabetes continues to be the leading cause of end-stage renal disease,” said Gabbay. “There is both a societal need and, fortunately, scientific evidence to support appropriate treatments.”
Black Americans with diabetes are three to four times more likely to have their limbs amputated than whites with the same condition, and Gabey says amputation rates are getting worse, not better.
New guidelines call for more careful screening for peripheral arterial disease, which can lead to foot ulcers and amputations.
Gavey said sleep quality and timing are important. “Not too much, not too little,” he said. “When it comes to diabetes, both are associated with poor outcomes.”
According to new guidelines, doctors should counsel diabetics about good sleep habits and identify those who have trouble sleeping.
Many people with diabetes are prone to sleep apnea, a dangerous condition in which breathing temporarily stops during sleep. Treatment for diabetes, especially weight loss, may improve sleep apnea and help control diabetes, he said.
All people with diabetes should be screened for problems that may interfere with proper diabetes management. For example, food insecurity, food deserts with few options, and living in “food swamps” where only processed foods are readily available. Said.
“Educating people about healthy eating when they can’t have access to healthy food will only lead to frustration,” Gabey said.
“I want the whole diabetes care team to get involved in asking people about more than just food,” El-Said said. “Have they lost their jobs? Are they safe?” Do you live in the area – before we tell you to exercise.
According to Gabbay, the value of community health workers has been demonstrated to help them stick to medications and lifestyle changes, especially for underserved and disadvantaged populations.
Improving access to technology
Physicians often assume that older people aren’t comfortable with technology, so they don’t recommend high-tech treatments such as automated insulin delivery devices or glucose pumps, Gabbay said.
Instead, new guidelines recommend providing everyone, including older patients, with the latest technology.
Blacks and other people of color often have less access to advanced technology than whites, so the Diabetes Association created a technology access program to promote racial equity.
“Everyone should have access to technology that can help them beat diabetes,” said Gavey.
When people are given technologies like continuous blood glucose meters, they often describe them as “innovative” and “game-changers,” Gavey said. Or we need to provide continuous glucose monitoring for people of all ages, including insulin dependent children, adults and the elderly.”
Are the changes enough?
While the change in guidelines is important and necessary, Leon Rock, co-founder of the African American Diabetes Association, says it’s too late to adequately address diabetes in blacks.
Historically, the American Diabetes Association has accused black people with diabetes of “gross neglect”, he said. It does not provide sufficient financial support to historically black university diabetes researchers.
“As money flows in and out of the ADA, it continues to flow to institutions such as Yale, Harvard, Boston University, and Boston College, rather than historically black schools. He said he wasn’t working hard enough.
“It’s a start,” Rock said.
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https://chicago.suntimes.com/well/2022/12/15/23507614/diabetes-care-updated-recommendations-aggressive-approach-to-weight-loss-cholesterol Diabetes Care: A Recommended More Proactive Approach for Overall Health