ADA releases Standards of Care 2024 with new screening and obesity management recommendations for diabetics
USA: The American Diabetes Association (ADA) has released new screening and obesity management recommendations for diabetes patients. The updated Standards of Care in Diabetes—2024 is available online and is published as a supplement to the January 2024 issue of Diabetes Care.
The ADA's Standards of Care for 2024 include new recommendations to screen for heart failure, type 1 diabetes risk, and peripheral arterial disease (PAD), along with new obesity management guidance. It also includes new recommendations related to bone health and liver disease. The Standards of Care are essentially the global guidelines for the care of individuals with diabetes and those at risk.
The ADA's Professional Practice Committee developed the document via a scientific literature review. The panel comprised 21 professionals, including physicians from many specialities, certified diabetes care and education specialists, nurse practitioners, pharmacists, and dieticians.
Recommendations were changed to encourage providers to incorporate anthropometric measurements beyond BMI, such as waist-to-hip ratio, waist circumference, and waist-to-height ratio.
New recommendations advise the use of GLP-1 receptor agonists or a GIP/GLP-1 dual agonist as the preferred pharmacotherapy for obesity management among people with diabetes and the reevaluation of obesity treatment intensification or deintensification to reach weight goals. Several updates in the metabolic surgery section discuss the long-term benefits of bariatric surgery.
A new recommendation on teplizumab use was added to the Standards section on prevention or delay of diabetes. Teplizumab was approved by the FDA in November 2022 to delay the onset of type 1 diabetes for adults and children aged 8 years and older.
An introductory section summarizing the changes for 2024 spans six pages. Those addressed during the briefing announced by ADA chief scientific and medical officer Robert Gabbay, include the following:
Heart failure screening: There has been an addition of two new recommendations to include screening of adults with diabetes for asymptomatic heart failure by measuring natriuretic peptide levels to facilitate the prevention or progression to symptomatic stages of heart failure.
"This is a really important and exciting area. We know that people with type 2 diabetes, in particular, are at high risk for heart failure," Dr Gabbay said, adding that these recommendations "are to more aggressively screen those at high risk for heart failure with a simple blood test and, based on those values, then be able to move on to further evaluation and echocardiography, for example. The recommendations are really to screen a broad number of individuals with type 2 diabetes because many are at risk, [particularly] those without symptoms."
Type 1 Diabetes Screening: In the recommendations, we talk about screening individuals, particularly first-degree relatives of someone with type 1 diabetes, that we know are at higher risk of developing type 1 [diabetes],” Gabbay said. “The message here is if we can catch individuals early, there are now FDA-approved treatments that can delay the development of type 1 diabetes, and I suspect there will be more in the not-too-distant future.”
This involves various new recommendations, including a framework for investigating suspected type 1 diabetes in newly diagnosed adults using islet autoantibody tests and diagnostic criteria for preclinical stages based on the recent approval of teplizumab for delaying the onset of type 1 diabetes.
PAD Screening: The Standards recommend PAD screening be performed with ankle-brachial index testing among asymptomatic people with diabetes aged 50 years and older with microvascular disease, foot complications or any end-organ damage from diabetes. Additionally, screening should be considered for all people with a diabetes duration of at least 10 years.
Other noteworthy changes to the 2024 Standards of Care include:
- Updated immunization guidance to include newly approved RSV vaccines in adults over 60 years of age with diabetes.
- Continued emphasis on inclusion and person-centred care.
- The importance of diabetes technology, with an emphasis on continuous glucose monitors (CGMs) and automated insulin delivery (AID) systems.
- More detail and emphasis on psychosocial screening protocols to better identify diabetes distress.
- New emphasis on cultural sensitivity in diabetes self-management education, with considerations for changing reimbursement policies.
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