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

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.