ADA updated standards of care for diabetes care
The American Diabetes Association (ADA) has presented updated standards of care for diabetes. The document details the indications for prescribing GLP-1 receptor agonists and other medications.
The ADA has published updated standards of medical care for diabetes 2024. The document details the indications for prescribing GLP-1 receptor agonists, dual GLP-1 receptor agonists and glucose-dependent insulinotropic peptide (GIP), SGLT2 inhibitors, and ACE inhibitors. In addition, information on prescribing hypolipidemic therapy for intolerance to statins has been updated.
In the section "Preventing or slowing the development of diabetes and related diseases," experts added a recommendation to prescribe teplizumab-mzwv infusion to prevent symptomatic type 1 diabetes (stage 3) in adults and children eight years of age and older with stage 2 disease.
Particular attention in the treatment of diabetes should be paid to weight control, the guidelines emphasize. The document suggests additional anthropometric measurements besides BMI - assessment of waist circumference, waist-to-hip ratio and waist-to-height ratio. GLP-1 receptor agonists or dual GLP-1 and glucose-dependent insulinotropic peptide (GIP) receptor agonists are proposed as pharmacotherapy for obesity in diabetes.
Insulin analogs or inhaled insulin are preferred over injectable human insulin to prevent hypoglycemia in type 1 diabetes. Earlier use of continuous glycemic monitoring is recommended to improve glycemic outcomes and prevent the development of hypoglycemia. Patients who are receiving insulin and those at high risk of hypoglycemia are indicated for glucagon administration.
In patients with type 2 diabetes and high risk of atherosclerotic cardiovascular disease, heart failure, and/or chronic kidney disease, treatment should include SGLT2 inhibitors and/or GLP-1 receptor agonists. SGLT2 inhibitors are recommended to prevent hospitalization for heart failure and improve glycemic control.
In adults with type 2 diabetes, GLP-1 receptor agonists and dual GIP and GLP-1 receptor agonists are preferred over insulin. When insulin therapy is used, a combination of insulin with GLP-1 receptor agonists and dual GIP and GLP-1 receptor agonists is indicated for greater glycemic efficiency.
In children ten years of age and older, who failed to achieve glycemic goals on the background of metformin (with or without insulin), administration of GLP-1 receptor agonists or empagliflozin is indicated. Before intensifying insulin therapy, the use of maximum tolerated doses of non-insulin drugs is recommended.
Patients with cardiovascular diseases against the background of diabetes, who receive ACE inhibitors, angiotensin receptor blockers, mineralocorticoid receptor agonists or diuretics, during the first 7-14 days after the start of therapy, monitoring of creatinine level/calculated glomerular filtration rate or potassium concentration is recommended.
In patients with diabetes and cardiovascular disease or suspected cardiovascular disease who cannot tolerate statins, bempedoic acid is recommended. PCDK9 inhibitor therapy with monoclonal antibodies, bempedoic acid, or PCSK9 inhibitors in combination with the small interfering RNA drug inclisiran is recommended as an alternative cholesterol-lowering therapy for patients with diabetes and atherosclerotic cardiovascular disease who are intolerant of statins.
The guideline also added a recommendation to use programs that use remote retinal imaging or FDA-approved artificial intelligence-based algorithms when screening for diabetic retinopathy.