The American Diabetes Association (ADA) has released the updated Standards of Medical Care in Diabetes for 2019 and it is endorsed by ACC.

With a view to lowering the cardiovascular burden that is often associated with diabetes, the ACC (American College of Cardiology) has endorsed these new standards, which include updates aimed at reducing heart attacks, strokes, heart failure and other manifestations of cardiovascular disease.

The overall aim is to reduce the CVD burden. The focus is to provide a patient-centric approach for diabetes care where the therapeutic approaches and medication selection is based on each patient's overall health status.

The updated standards include several important updates and additions about;

1. Recommendations for greater personalisation of care and the need for ongoing assessment. A new “Goals of Care “ graphic decision cycle details the need for ongoing assessment and shared decision-making to achieve care goals, help reduce therapeutic inertia and improve patient self-management.

2. Guide for health care professionals about the appropriate use of language to communicate about diabetes with patients and professional audiences.
3. Guidance on the management of new-onset diabetes in overweight youth with the help of a new chart (Refer the figure below)
   

4. Emphasis on shared decision-making.
5. Expanded treatment recommendations for children and adolescents with type 2 diabetes.
6. Informative text on diabetes and technology, including the use of telemedicine: The section focuses on diabetes technology including new recommendations on insulin delivery (syringes, pens and insulin pumps), blood glucose meters, continuous glucose monitors (real-time and intermittently scanned), and automated insulin delivery devices (such as the artificial pancreas).
7. Guidance on medical nutrition: The section emphasises that there is no one-size-fits-all eating pattern and that a variety of eating patterns can help manage diabetes. It is recommended for patients to be referred to and work with a registered dietitian to create a personalized nutrition plan. A recommendation is updated to emphasize the benefits of consuming more water and fewer beverages sweetened with either nutritive (caloric) or nonnutritive (noncaloric) sweeteners.
8. Pharmacologic approaches to glycemic treatments: The recommended pharmacologic treatment for type 2 diabetes is significantly updated to align with and reflect the new ADA-EASD Consensus Report, specific consideration of important comorbidities, such as ASCVD, chronic kidney disease and heart failure and key patient factors, such as hypoglycaemia risk, body weight, costs, and patient preference.

9. A revised approach for injectable medication therapy is included: For patients who require the additional glucose-lowering efficacy of an injectable medication, a GLP-1 receptor agonist is now recommended as the first choice before insulin for most patients with type 2 diabetes. Gabapentin is included as a new medication to be considered for the treatment of neuropathic pain in people with diabetes based on the latest data that indicates strong efficacy and the potential for cost savings. 

Source: http://care.diabetesjournals.org/content/42/Supplement_1