by Vivian Fonseca, MD, FRCP
Univadis Advisory Editor in Endocrinology
The American Diabetes Association (ADA) recently issued its revised Standards of Care for 2017 (summarized here). There are several changes to these guidelines this year. Therefore, it is important that anyone involved in the care of a patient with diabetes read them. The overall standards are long and detailed, but are summarized in one of the articles in the supplement. Here, I highlight and summarize are few of the most important changes.
- Screening for diabetes is emphasized again, but with some clarification on whom to screen and an example of a validated tool to use for screening.
- The evaluation of a patient highlights the importance of comorbidities, including assessing sleep pattern, HIV, and various psychiatric disorders.
Several changes were made to pharmacological therapy:
- The recognition of vitamin B12 deficiency with metformin use is new but important, as it may contribute to neurological problems.
- The costs/affordability of medication have been highlighted, including the high cost of insulin (which was previously considered inexpensive).
- Recent cardiovascular outcome trials are discussed to support a recommendation to use empagliflozin or liraglutide in high-risk patients with cardiovascular disease.
Although these may be the most important/novel updates, the standards have been updated and clarified in several areas and will probably affect clinical practice significantly.