Standards of Care in Diabetes 2024: ADA updates recommendations on hypoglycemia prevention and management

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.

This article will focus mainly on updated recommendations on hypoglycemia prevention and management. Recommendations are described below:

Hypoglycemia Assessment, Prevention, and Treatment

• History of hypoglycemia should be reviewed at every clinical encounter for all individuals at risk for hypoglycemia and evaluated as indicated.
• Clinicians should screen all individuals at risk for hypoglycemia for impaired hypoglycemia awareness.
• Clinicians should consider an individual’s risk for hypoglycemia when selecting diabetes medications and glycemic goals.
• The use of CGM (continuous glucose monitoring) is beneficial and recommended for individuals at high risk for hypoglycemia.
  
• Glucose is the preferred treatment for the conscious individual with glucose <70 mg/dL (<3.9 mmol/L), although any form of carbohydrate that contains glucose may be used. Fifteen minutes after initial treatment, repeat the treatment if hypoglycemia persists.
• Glucagon should be prescribed for all individuals taking insulin or at high risk for hypoglycemia. Family, caregivers, school personnel, and others providing support to these individuals should know its location and be educated on how to administer it. Glucagon preparations that do not have to be reconstituted are preferred.
• All individuals taking insulin A or at risk for hypoglycemia C should receive structured education for hypoglycemia prevention and treatment, with ongoing education for those who experience hypoglycemic events.
• One or more episodes of level 2 or 3 hypoglycemia should prompt reevaluation of the treatment plan, including deintensifying or switching diabetes medications if appropriate.
• Refer individuals with impaired hypoglycemia awareness to a trained healthcare professional to receive evidence-based intervention to help reestablish awareness of symptoms of hypoglycemia.
• Ongoing assessment of cognitive function is suggested with increased vigilance for hypoglycemia by the clinician, patient, and caregivers if impaired or declining cognition is found.

Reference:

American Diabetes Association Professional Practice Committee; 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S111–S125. https://doi.org/10.2337/dc24-S006