2019 ADA Standards of Care: changes promote patient-centered approach

  • Diabetes Care supplement

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Many of the 2019 revisions in the annual American Diabetes Association (ADA) Standards of Care further promote individualization of diabetes mellitus (DM) care.  

2019 changes include:  

  • Diagnostic criteria now include 2 abnormal test results (i.e., fasting glucose and HbA1c) from same blood sample.
  • New recommendation to include 10-year atherosclerotic risk as part of overall assessment.
  • Expanded nutrition section covers individualized macronutrient distribution, including identification of candidates for low-carbohydrate eating patterns.
  • New technology section addresses devices for insulin delivery, glucose monitoring, and closed-loop systems.
  • Self-blood glucose monitoring in adults with type 2 diabetes (T2D) not at risk for hypoglycemia now acknowledged as having minimal benefit.
  • Pharmacologic treatment of T2D now based on ADA-European Association for the Study of Diabetes consensus report, with consideration of individual risks for cardiovascular and kidney disease, weight effects, hypoglycemia, costs, and patient preferences.  
  • New section addresses insulin injection technique.
  • Gabapentin added for treating diabetic neuropathic pain.
  • Foot exams at every visit now recommended only for patients at high ulceration risk; annual exams still recommended for all.
  • New recommendations for older adults include regimen simplification.
  • Section on T2D in youth significantly expanded.
  • Previous report about insulin access and affordability republished.
  • First-time endorsement of ADA document by the American College of Cardiology.

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