Every year in January, the ADA releases its updated standards of diabetes care.

Standards of Care in Diabetes—2023. Diabetes Care. 2022. 46:S1–S4.

The 2023 version has many more changes than usual, with about 100 new or revised recommendations relating to obesity, hypertension, heart failure, social determinants of health, and lipid management.

 

HCPs in all specialties will need to be aware of these revised standards when caring for patients with diabetes. An abridged version of the standards prepared for PCPs may help them (and all HCPs) more easily digest the information.

Standards of Care in Diabetes—2023 abridged for primary care providers. Clin Diabetes. 2023;41(1):4–31.

 

 

Main updates in 2023 standards

Shira Eytan, MD, an endocrinologist practicing in New York City, commented on the 2023 guidelines to MDLinx.

The updated guidelines take into account that diabetes is a multifaceted disease that is best controlled by targeting multiple lifestyle aspects and by treating with medications that have added benefits to protect from complications of diabetes.

A press release from the ADA detailed the main updates in the 2023 standards of care:

American Diabetes Association releases 2023 Standards of Care in Diabetes to guide prevention, diagnosis, and treatment for people living with diabetes. American Diabetes Association. December 12, 2022.

 

• An emphasis on recommending weight loss (up to 15% of total weight)

• A focus on the importance of sleep health and physical activity

• Discussion of consideration of social aspects of health when delivering care

• New hypertension diagnosis cutoffs that align with the current definition of hypertension according to the ACC/AHA (hypertension is now defined as a systolic blood pressure ≥ 130 mmHg or a diastolic blood pressure ≥ 80 mmHg)

• An expansion of the role of SGLT2 inhibitors

• Discussion of the role of finerenone in patients with diabetes and chronic kidney disease with albuminuria

• New lipid management recommendations with lower LDL goals for high-risk patients

• Hyperglycemia updates that align with a consensus report issued in September 2022

  Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 Diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45(11):2753–2786.

   

• The assertion that if lifestyle changes and weight loss do not help patients meet their goals, pharmacologic therapy should be initiated, with the preference being glucagon-like peptide-1 (GLP-1) agonists instead of insulin when possible

• A recommendation for an A1C goal for most adults of <7% without significant hypoglycemia was made

 

 

Additional noteworthy updates

The new standards of care also cover technology, testing, and more, including:

• The benefits of digital health, telehealth, and telemedicine

• Expansion of nonalcoholic fatty liver disease recommendations

• The usefulness of point-of-care A1C testing for diabetes screening and diagnosis

• Helping older adults use technology for diabetes

• Screening patients for food insecurity

• Updates in vaccination recommendations for people with diabetes

• Use of inclusive language in providing diabetes care

• Updated information on COVID-19 and diabetes

 

Focus on obesity and weight management

Important language was added to the standards to reinforce the concept that obesity is a chronic disease, and that both small and large weight-loss goals should be developed on an individual basis.

ElSayed NA, Aleppo G, Aroda VR, et al. Summary of revisions: Standards of Care in Diabetes—2023. Diabetes Care. 2023;46(Suppl. 1):S5–S9.

 

The standards state that larger weight loss of 10% or more may actually have disease-modifying effects, such as diabetes remission. It may also improve cardiovascular outcomes.

We know that lifestyle modification such as weight loss helps with diabetes management, and having medications that show great efficacy in weight loss offers us the ability to control diabetes more effectively.

“Larger weight loss goals could cause disease remission and could be achievable in the correct group of patients,” Dr. Eytan added. “These guidelines also acknowledge that weight management is a long-term goal and that maintenance programs should be offered.”

With maintenance programs in mind, Anastasia Climan, RDN, CD-N, said, “I agree that a combination of nutrition, physical activity, and behavioral therapy is necessary to treat diabetes. Many people fall off the radar with their healthcare appointments, so setting someone up with frequent counseling could make a significant difference in their long-term success.”

In my experience, group classes are particularly motivating for patients. When they find a social support group for managing diabetes, they're more likely to show up and feel motivated to make positive changes.

“Ongoing monitoring of body weight is also a proven method for improving long-term weight loss,” Climan added. “The National Weight Control Registry (which follows people who have maintained weight loss) reports that weighing in once a week is a common factor for success.”

The National Weight Control Registry. 2023.

 

 

Diabetes and COVID-19

The 2023 standards state that helping patients with diabetes achieve glycemic control will reduce the risk of COVID-19 and its complications. They recommend that patients who have been infected with COVID-19 should be followed up long-term to be assessed for complications and possible symptoms of long COVID.

The standards do not include a recommendation to change prescriptions for glucose-lowering therapy in people with diabetes infected by COVID-19.

 

 

Become familiar

As time is tight for many clinicians, they may want to avail themselves of the abridged version aimed at PCPs, which provides the highlights and focuses on the major updates to be aware of moving forward.