The American Diabetes Association (ADA) recently released its 2022 Standards of Medical Care in Diabetes. Every year, the ADA’s Professional Practice Committee reviews new, diabetes-related research and consults with subject matter experts to provide HCPs with up-to-date guidelines on the diagnosis and management of diabetes.

The new guidelines this year put an emphasis on diabetes screening, management of complications and comorbidities, and use of technology, as well as individualized diabetes care. 

We summarize specific updates in this year’s Standards of Care below. 

Diabetes screening

The ADA is now recommending adults without risk factors be screened for prediabetes and type 2 diabetes starting at age 35. Previously, the recommended age for screening was 45. This important change will allow clinicians to identify individuals at risk much earlier than they would have under the old guidelines. According to the CDC, out of 34.1 million adults over age 18 living with diabetes in 2018, 21.4% met the laboratory criteria for diabetes but were not aware of having diabetes. 

The new guidelines also recommend that all women who are planning to become pregnant, especially if they have any underlying risk factors, be screened for diabetes with a fasting glucose test. For unplanned pregnancies, the ADA recommends women be screened at the first prenatal visit. However, guidelines for screening for gestational diabetes between weeks 24 and 28 of pregnancy have not been updated. 

Managing risk of comorbidities and complications

The new guidelines emphasize the need for individualized treatment plans based on patients’ comorbidities and risk of complications. While metformin has long been the first-line therapy for managing diabetes, clinicians can now use GLP-1 receptor agonists or SGLT2 inhibitors instead of, or in addition to, metformin. 

These medications are recommended for patients who are at risk for chronic kidney disease (CKD), atherosclerosis, and heart failure to slow disease progression and reduce the risk of future cardiovascular events. 

In the event that SGLT2 inhibitors cannot be used, HCPs can prescribe finerenone, a nonsteroidal mineralocorticoid receptor antagonist, instead. 

The new guidelines also include additional recommendations for managing high cholesterol and hypertension in the patients with diabetes. 

Diabetes technology 

The updated Standards of Care contains expanded recommendations for continuous glucose monitoring (CGM) as well as updated guidelines on using diabetes technology in hospital settings. 

Previously, the ADA recommended CGM for individuals taking rapid-acting insulin (such as Humalog, Novolog, and others). This year’s guidelines now include patients who take only long-acting insulin, as well as children with type 1 and type 2 diabetes who take rapid-acting insulin. 

The ADA has also highlighted the importance of ongoing training and education for patients and their caregivers on how to properly use diabetes technology. 

The 2022 guidelines also aim to increase hypoglycemia awareness in patients as well. The ADA notes that hypoglycemia unawareness is a critical medical problem in patients with type 1 diabetes, as well as in patients with type 2 diabetes who have a severe insulin deficiency. The new guidelines allow insulin-treated patients with hypoglycemia unawareness to raise their glycemic targets for a few weeks, as there is now evidence that this can help to improve their awareness of hypoglycemia episodes. 

Vaccine recommendations

The ADA is recommending that all adults and eligible children with diabetes receive COVID-19 vaccines. Given that diabetes is a risk factor for serious COVID-19-related complications, the ADA suggests that, similar to the annual flu shot, the COVID-19 vaccine will likely become a component of annual preventative measures for individuals with diabetes. 

"We recognize that healthcare providers around the world look to our Standards of Care for the latest in how new research can impact care and are excited to provide this valuable resource," said Dr. Robert Gabbay, Chief Scientific & Medical Officer at the ADA, in a press release. "The evidence for the prevention and treatment of diabetes and its complications is constantly evolving and it is crucial we do our best to keep medical professionals informed on best practices and medical advances in the field of diabetes."

Sources

1. American Diabetes Association Professional Practice Committee. Summary of revisions: standards of medical care in diabetes—2022. Diabetes Care. 2022;45(Supplement _1):S4-S7.

2. Kenney J, Briskin A. Your guide to the 2022 changes to the ADA Standards of Care. diaTribe. January 10, 2022. 

3. National and state diabetes trends. CDC. January 4, 2021. 

4. The ADA’s 2022 Standards of Medical Care in Diabetes update. National Institute of Diabetes and Digestive and Kidney Diseases. February 23, 2022. 

5. Latest ADA annual Standards of Care includes changes to diabetes screening, first-line therapy, pregnancy, and technology [press release]. ADA. December 20, 2021.