2020 updates to the standards of diabetes care


The American Diabetes Association recently updated the standards of diabetes care for 2020. Please refer to the full article, titled American Diabetes Association Standards of Medical Care in Diabetes — 2020, for complete details.

Here are some highlights:*

  1. A new recommendation for “testing for prediabetes and/or type 2 diabetes should be considered in women planning pregnancy [who may be overweight or obese] and/or who have one or more additional risk factors for diabetes.” (See page S18.)
  2. “The section “Nutrition” was updated and a new recommendation (3.3) was added to recognize that a variety of eating patterns are acceptable for people with prediabetes." (See page S4.)
  3. “Based on intervention trials, a variety of eating patterns may be appropriate for patients with prediabetes, including Mediterranean and low-calorie, low-fat eating patterns...(all) with an emphasis on whole grains, legumes, nuts, fruits and vegetables and minimal reined and processed foods, is also important.” (See page S33.)
  4. "Patients with type 1 diabetes should be screened for autoimmune thyroid disease soon after diagnosis and periodically thereafter. Adult patients with type 1 diabetes should be screened for celiac disease in the presence of gastrointestinal symptoms, signs, or laboratory manifestations suggestive of celiac disease.” (See page S42.)
  5. “In patients taking medication that can lead to hypoglycemia, investigate, screen, and assess risk for or occurrence of unrecognized hypoglycemia, considering that patients may have hypoglycemia unawareness.” (See page S72.)
  6. “Measure height and weight and calculate BMI at annual visits or more frequently.” (See page S89.)
  7. “For patients with established ASCVD or indicators of high ASCVD risk…established kidney disease, or heart failure, an SGLT-2 inhibitor or GLP 1-RA with demonstrated CVD benefit is recommended as part of the glucose-lowering regimen independent of A1C and in consideration of patient-specific factors.” (See pages S102-105.)
  8. “Patients with urinary albumin >30 mg/g creatinine and/or an eGFR <60 mL/min/1.73m2 should be monitored twice annually to guide therapy.” (See page S135.)
  9. “A1C goals must be individualized and reassessed over time. An A1C of <7% (53 mmol/mol) is appropriate for many children. Less-stringent A1C goals (such as <7.5% [58 mmol/mol]) may be appropriate for patients who cannot articulate symptoms of hypoglycemia; have hypoglycemia unawareness; lack access to analog insulins, advanced insulin delivery technology, and/or continuous glucose monitors; cannot check blood glucose regularly; or have nonglycemic factors that increase A1C (e.g., high glycators). Even less-stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, or extensive comorbid conditions.” (See page S166.)
  10. “After the initial examination, repeat dilated and comprehensive eye examination every 2 years. Less frequent examinations, every 4 years, may be acceptable on the advice of an eye care professional and based on risk factor assessment, including a history of glycemic control with A1C <8%.” (See page S170.)
  11. “If glycemic targets are no longer met with metformin (with or without basal insulin), liraglutide (a glucagon-like peptide 1 receptor agonist) therapy should be considered in children 10 years of age or older if they have no past medical history or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2.” (See page S172.)

*Source: American Diabetes Association Standards of Medical Care in Diabetes — 2020. Diabetes Care. The Journal of Clinical and Applied Research and Education. Vol. 43 | Supplement 1. January 2020. care.diabetesjournals.org/content/diacare/suppl/2019/12/20/43.Supplement_1.DC1/Standards_of_Care_2020.pdf (last accessed 22 March 2020)