The American Diabetes Association (ADA) has released its latest guidelines outlining new standards for diabetes care. Although the standards are updated annually, this year includes almost 100 new or revised recommendations affecting all types of diabetes.
The guidance, which includes stricter recommendations, aims to improve health inequities by screening at-risk populations for food and housing insecurity and connecting them with community resources.
“The updates in the 2023 Standards of Care are a testament to how far we’ve come as a medical community, in terms of better medications/technologies enabling more aggressive targets for health, and in terms of being more aware of health disparities,” Dr. David Ahn, an endocrinologist and program director of the Mary & Dick Allen Diabetes Center at Hoag Hospital, told Healthline.
Here is what you need to know about the new guidelines:
This year’s guidance emphasizes the importance of weight control and tackling obesity, which is a risk factor for diabetes and can contribute to health complications like high blood pressure, high cholesterol, and high glucose levels.
The new guidelines suggest that losing 15% of body weight, as opposed to the previously recommended 5% should yield more for your health, according to Dr. Robert Gabbay, chief science and medical officer for the diabetes association.
New technologies have advanced diabetes care
The new guidance also highlights new technologies that have helped improve diabetes care including telehealth, digital health, and telemedicine.
It also pointed to new evidence supporting the use of continuous glucose monitors (CGM) was included with the goal of improving access to CGM use.
“We have new medications and technologies every few years that revolutionize how we care for people with diabetes,” Dr. Thomas Grace, a family medicine doctor specializing in diabetes and medical director of the Blanchard Valley Diabetes Center says.
Quality sleep is key
The guidance also includes new recommendations related to modifiable lifestyle factors, including sleep and exercise.
According to Gabbay, both the quality and timing of your sleep are important. “Not too much and not too little,” he said. “Both are associated with poorer outcomes when it comes to diabetes.”
If you have diabetes and are experiencing regular sleep issues, you should be screened for sleep health and see a sleep specialist.
“Sleep is often under-recognized as a contributor to higher blood sugar and weight gain,” Ahn said, He added that untreated sleep conditions like sleep apnea can contribute to high blood pressure and higher blood sugar levels.
A healthy diet, regular physical activity, good sleep hygiene, psychological well-being, tobacco cessation are also important for diabetes care, according to the guidance.
New strategies for racial inequities
The guidelines also offer new strategies for addressing racial inequities. Alaskan Native, Black, and Hispanic people have a greater risk for diabetes and experience poorer health outcomes.
Furthermore, diabetes medications, like insulin, tend to be expensive, which help contribute to health disparities across the United States, according to Grace.
At-risk populations should be screened for food insecurity, housing insecurity, financial barriers, and community support.
In addition, patients should be referred to community workers or health coaches who can help support their care and management of risk factors.
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Cardiovascular and kidney disease prevention
Diabetes is the leading cause of heart disease and heart disease is the leading cause of death for people with diabetes, Gabbay noted.
The new guidelines, which are aligned with the American College of Cardiology, include a lower target for blood pressure of less than 130 over 80. For LDL cholesterol, the bad kind, the new guideline calls for a measurement of 70 for people without heart disease (down from 100) and 55 instead of 70 for those with established heart disease.
The guidelines also suggest that aggressive treatment can prevent the progression of chronic kidney disease. “Diabetes continues to be the leading cause of end-stage renal disease,” Gabbay added.
Amputation prevention
Black Americans with diabetes are three- to four times more likely to have a limb amputated than a white person with the same condition, according to Gabbay. Unfourtanetly, the rate of amputations is getting worse, not better.
The new guidelines suggest more careful screening for foot ulcers and peripheral arterial disease, both of which can lead to amputations.
