The American Diabetes Association® (ADA) issued important updates to the 2019 Standards of Medical Care in Diabetes (Standards of Care) today, in annotations as the Living Standards of Care, with the changes focusing on new metrics for continuous glucose monitoring (CGM) utilization and new medication options and recommendations for youth and adults with type 2 diabetes. The updates were informed by newly published research and crafted and approved by the ADA’s Professional Practice Committee, which is responsible for producing the annual Standards of Care. Updates to Section 10, Cardiovascular Disease and Risk Management, have also been reviewed and approved by the American College of Cardiology, who endorse this section. The Living Standards of Care are available immediately online at Diabetes Care.
Today’s updates to the Living Standards of Care include information added to the following sections:
- Section 6, Glycemic Targets, and Section 7, Diabetes Technology, have been revised to incorporate the new international consensus report on continuous glucose monitoring (CGM) time-in-range goals. A table has been added to help standardize CGM metrics for clinical care and an example of an ambulatory glucose profile has been added to encourage consistency in CGM data report interpretation.
- Section 9, Pharmacologic Approaches to Glycemic Treatment, and Section 10, Cardiovascular Disease Risk Management, have been updated to reflect the results of the Researching Cardiovascular Events With a Weekly Incretin in Diabetes (REWIND) trial, which indicated dulaglutide reduced the risk for nonfatal myocardial infarction, nonfatal stroke and cardiovascular death in adults with type 2 diabetes with and without established cardiovascular disease. Dulaglutide is now recognized among other GLP1 receptor agonists that have demonstrated macrovascular benefits in people with type 2 diabetes.
- Revisions to Section 13, Children and Adolescents, are the result of the U.S. Food and Drug Administration’s approval of injectable liraglutide in pediatric patients with type 2 diabetes who are 10 years of age and older, and the Liraglutide in Children and Adolescents with Type 2 Diabetes study, which examined the drug’s effects on youth. This is the first non-insulin medication approved to treat type 2 diabetes in the pediatric population since 2000.
“As ongoing research and data lead to improved treatment recommendations for people with diabetes, the ADA’s Living Standards of Care continue to be revised accordingly, and new updates, such as the time-in-range goals, allow clinicians and researchers in the field to stay abreast of the most accurate guidelines,” said the ADA’s Chief Scientific, Medical and Mission Officer William T. Cefalu, MD. “As technology surrounding continuous glucose monitoring evolves, CGM has the opportunity to positively impact the future of diabetes care and research, and establishing standard, official time-in-range recommendations is necessary for the clinical care, regulatory oversight and research efforts related to CGM.”
“The new time-in-range goals and ambulatory glucose profile that are part of the ADA’s Living Standards updates were developed by a panel consisting of individuals with diabetes, physicians and researchers from around the world who are experts in CGM technologies and diabetes research and care,” said consensus panel member Richard M. Bergenstal, MD, executive director of the International Diabetes Center at Park Nicollet, in Minneapolis, Minnesota. “These guidelines provide the tools for improved consistency for clinicians, researchers, and individuals with diabetes to utilize, and we are pleased that the American Diabetes Association is one of the many professional diabetes organizations around the world to endorse this international consensus report.”
The Standards of Care provide the latest in comprehensive, evidence-based recommendations for the diagnosis and treatment of children and adults with type 1, type 2 or gestational diabetes; strategies to improve the prevention or delay of type 2 diabetes; and therapeutic approaches that reduce complications and positively affect health outcomes. Beginning in 2018, the ADA updates and revises the online version of the Standards of Care throughout the year, with annotations for new evidence or regulatory changes that merit immediate incorporation. The online version of the Standards of Careincludes any research updates or policy changes that have been approved throughout 2019.
Updates to the Standards of Care are established and revised by the ADA’s Professional Practice Committee (PPC). The committee is a multidisciplinary team of 15 leading U.S. experts in the field of diabetes care and includes physicians, diabetes educators, registered dietitians and others whose experience includes adult and pediatric endocrinology, epidemiology, public health, lipid research, hypertension, preconception planning and pregnancy care. For the 2019 Standards of Care, two designated representatives from the American College of Cardiology (ACC) reviewed, provided feedback and endorsed the recommendations for cardiovascular disease and risk management on behalf of the ACC. The ACC designated representatives also reviewed and approved the updates made to the cardiovascular disease and risk management section. The PPC performs an extensive, global clinical diabetes literature search each year for the annual Standards of Care update, supplemented with input from ADA leaders and staff and the medical community at-large. Members of the PPC must disclose potential conflicts of interest with industry and/or relevant organizations; these disclosures are available on page S184 of the 2019 Standards of Care.
The complete, annotated Standards of Care, which includes updates made today, can be accessed online on Diabetes Care. The Abridged Standards of Medical Care in Diabetes have also been updated and can be accessed online on Clinical Diabetes.