January 7, 2019
If you have diabetes, it is best for you to regularly communicate with your doctor not only about your A1C, but also about things like your mental health and blood pressure. Experts say this is one of the most important findings from new guidelines from the American Diabetes Association (ADA).
The ADA Standards for Medical Care in Diabetes-2019, which was Published in the January 2019 issue of Diabetes careInclude several guidelines intended to engage you in the conversation with your doctor in an effort to improve your health and quality of life.
“This is really a paradigm shift in that we want patient involvement. We want an educated patient. We want a provider-patient dialogue,” says William T. Cefalu, MD, chief scientific, medical and mission officer at ADA.
RELATED: 10 People Who Can Help You Manage Type 2 Diabetes
What are the ADA Standards of Care and why should you care?
The ADA releases its Standards of Care Report each year to reflect scientific advances in the treatment of diabetes. The recommendations stem from evidence-based research on the diagnosis and treatment of children and adults with type 1, type 2 or gestational diabetes. The report also includes strategies to prevent or delay type 2 diabetes, and treatment approaches to reduce complications associated with type 2 diabetes and help improve health outcomes.
A panel of 15 prominent American diabetes care experts wrote the documents. This team includes physicians, certified diabetes educators, registered dietitians, and other specialists in the areas of adult and pediatric endocrinology, epidemiology, public health, lipid research, hypertension, preconception planning, and pregnancy care. This year, two representatives from the American College of Cardiology (ACC) reviewed, provided feedback, and approved recommendations for cardiology and risk management on behalf of the ACC.
An online version of the Standards of Care, called the Living Standards of Care, will continue to be updated in real time throughout 2019 if new evidence or regulatory changes merit immediate incorporation.
“In 1989, the entire Standards of Care was about four pages long. This year, it’s about 200 pages,” Dr. Cefalu says. The evidence comes in so fast, you can’t wait a year to update it. Instead of waiting for a whole year, we’ve moved on. into a system in which we can constantly update with new information.”
An overview of the 2019 ADA Standards of Care key principles
Here are some of the major changes and takeaways from the new report:
Emphasis on protecting heart health in diabetic patients
The 2019 Standards of Care consider the multiple health and lifestyle factors of each person with diabetes. For the first time, the ADA has collaborated with the American College of Cardiology to ensure that ADA recommendations are in compliance with Heart health guidelines. Standards of Care also support the new ADA Initiative to know diabetes through the heart, in association with the American Heart Association. These efforts aim to reduce deaths from cardiovascular disease, which is the leading cause of death for people with diabetes, according to the ADA. according to Centers for Disease Control and Prevention (CDC)People with type 2 diabetes are twice as likely to die from heart disease as people without the disease.
For patients, this guideline means talking to an endocrinologist, certified diabetes educator, and others involved in diabetes care about heart health, too.
“We partner with the American Heart Association to educate patient about cardiovascular disease,” Cefalu says. “We want the patient to be educated and to discuss this with their doctors.”
Related: How are diabetes and heart disease linked?
The guidelines update recommendations regarding the medications that are most beneficial for people with diabetes and cardiovascular disease. These include sodium-glucose transporter 2 (SGLT-2) inhibitors, such as Farxiga (dapagliflozin), and glucagon-like peptide-1 (GLP-1) receptor agonists, such as Ozempic (semaglutide).
“A drug treatment approach is really different about whether or not a person has cardiovascular disease,” he says. Robert Gabbay, MD, Ph.D., chief medical officer of the Joslin Diabetes Center in Boston. “There are now medications for people with cardiovascular disease that not only reduce blood sugar but reduce cardiovascular disease death. The first thing you need to know is whether or not a patient has cardiovascular disease,” the ADA said.
More personalized diabetes care
The new guidelines recommend that people with diabetes undergo ongoing evaluations and work with their doctors to make decisions about their care. The document contains a file Care plan goals It outlines the range of topics you can discuss with your doctor, depending on your needs.
“We put the patient at the center of the treatment,” Cefalu says. “Instead of just managing complications, we put quality of life first. We look at things like motivation and depression and put things in a social and economic context. If a patient can’t afford the most expensive drug why would he prescribe it? There is a joint decision-making process with the patient.”
Studies show that patients stick to treatment plans better if they are involved in choosing treatments and strategies, says Dr. Gabay.
“Diabetes is not a simple thing,” he says. Because of that, there are a lot of decisions to be made. The question is: How does one do that? It has to be patient-centered, which means there is a shared decision-making process.”
Cefalu adds that it’s important for healthcare professionals to use language that patients can understand.
“The first thing is to provide awareness that the provider and the patient need to speak the same language.”
The updated instructions also include a file Department of Nutrition and Physical Activity For people 65 years of age or older. The document also includes information to help simplify treatment in the elderly.
Likewise, the guidelines include Recommendations for children and adolescents with type 2 diabetes which includes the ADA’s guidance on youth statement, which was Posted in December 2018 in Diabetes care. These recommendations now include a comprehensive plan for children and adolescents regarding screening, diagnosis, lifestyle management, treatment, heart health, obesity, and psychosocial factors affecting young people with this disorder.
Related: A complete guide to eating a diabetes-friendly diet
Focus on developing customized diabetes diets
According to the new guidelines, there is no one “correct” eating pattern for every person with diabetes. A variety of eating patterns can be used to manage diabetes, and the new guidelines suggest referring people with diabetes to a registered dietitian for help creating a personalized nutrition plan.
“Standards of care include the very latest in nutrition,” Cefalu says. There is no single diet for all people with diabetes. It’s an individual approach.”
Research suggests there isn’t much difference between some of the medically acceptable diets, says Gabe. What matters most is whether a person with diabetes can continue the diet and make long-term changes to their lifestyle.
“What we’ve realized, in terms of lifestyle changes, is that one size doesn’t fit all,” he says. In my practice, I ask patients, ‘What have you been successful at in the past? “Maybe this is as good a sign as anything else.”
The new guidelines also emphasize the benefits of drinking more water and reducing sweetened drinks, including drinks with zero-calorie sweeteners.
Related: Following a Low-Carb Diet to Manage Type 2 Diabetes: Keto, Paleo, or Atkins Best?
Learn about the role of technology in managing diabetes
Experts say technological innovations are shaping the way people deal with diabetes. The 2019 guidelines provide expanded information on a variety of new syringes, pens, insulin pumps, blood glucose meters, continuous glucose monitors, and automated insulin delivery devices to guide patients interested in these products.
“This is probably the fastest-growing area,” Cefalu says. “Continuous glucose monitoring, especially for type 1 diabetes, has truly revolutionized care.”
RELATED: The Best Blood Sugar Monitors To Help You Manage Diabetes
How people with diabetes can benefit from the new ADA guidelines
Although the guidelines are used by healthcare professionals to manage care, the updates are meant to benefit those who manage diabetes, and those people should be aware of the changes, Cefalu says. Brief Care Standards Publicly available on the ADA website.
People with diabetes can also receive information about guidance in diabetes classes and support groups, he says. “We have many consumer programs. Our standards of care are the backbone of what we do. This information is published in many, if not most, patient information sets,” including the free ones Type 2 Diabetes Coping Program.
Above all, the guidelines encourage people with diabetes to ask questions and feel comfortable discussing a range of issues with health care providers, including issues of adherence to diabetes treatment, depression, and costs of care.
“They have to fend for themselves,” Gabbay says. “One of the simplest ways is to ask a lot of questions. If the doctor says, we should start taking this drug, the patient can ask ‘What are the advantages of this drug and are there other drugs?'”
Related: Best diabetes treatment options to improve blood sugar control
He says people who manage their diabetes can continue their care in other ways, such as keeping track of annual checkups, such as eye exams or foot exams.
Gabay adds that they should educate themselves about diabetes.
“One of the most powerful things for people with diabetes is to be aware of their diabetes and how to best manage their disease,” Gabbay says. “It is basically a self-managed disease. Talk to your provider about strategies.”
Related: An essential guide to talking to your doctor about basal insulin