ADA 2023 Standards of Care in Diabetes

The American Diabetes Association’s 2023 Standards of Care reflect changes in technology, improved medications, and a deeper understanding of the social factors that contribute to disease and diabetes control

The American Diabetes Association (ADA) publishes annually-updated Standards of Care in Diabetes – comprehensive, evidence-based guidelines for the prevention, diagnosis, and treatment of diabetes.

Based on the latest scientific research and clinical trials, the 2023 Standards of Care include new and updated practice guidelines to care for people with diabetes and pre-diabetes, including for the diagnosis and treatment of youths and adults with type 1, type 2, or gestational diabetes; strategies for the prevention or delay of type 2 diabetes and associated comorbidities; and therapeutic approaches that can reduce complications, mitigate cardiovascular and renal risk, and improve health outcomes.

“The field of diabetes is changing fast. ADA’s Standards of Care strives to provide up-to-date guidance using the best available evidence rigorously and comprehensively,” said Dr Nuha El Sayed, the ADA’s Professional Practice Committee Chair.

This year, the ADA Standards in Care included almost 100 new or revised recommendations affecting all types of diabetes. New guidelines include updates to recommendations around obesity, hypertension, heart failure medication, social determinants of health, and lipid management.

“This year’s annual report provides necessary guidance that considers the role health inequities play in the development of diabetes, particularly for vulnerable communities and communities of colour disproportionately impacted by the disease. This guidance will ensure healthcare teams, clinicians, and researchers treat the whole person,” said Chuck Henderson, Chief Executive Officer for the ADA.

Throughout the 2023 guidance and within the treatment algorithms, weight loss is now given equal importance to glycaemic control, cardiovascular disease, heart failure, and renal disease. Encouragement to lose weight should underpin type 2 diabetes care the guidance says:

• Moderate weight reduction (approximately 3-to-7 per cent of baseline weight) improves glycaemia and other intermediate cardiovascular risk factors.

• Substantial and enduring weight reduction (10-to-15 per cent), achievable with total diet replacements or current pharmacotherapy, usually confers greater benefits, including disease-modifying effects and possible remission of type 2 diabetes, and may improve long-term cardiovascular outcomes and mortality.

Notable updates to the Standards of Care in Diabetes 2023 include:

• Emphasis on supporting higher weight loss (up to 15 per cent) based on the efficacy of and access to newer medications when appropriate.

• New recommendations related to sleep health and physical activity in people with diabetes.

• Broad consideration of social determinants of health in guiding the design and delivery of care.

• New hypertension diagnosis cut-offs (hypertension is now defined as a systolic blood pressure ≥130mmHg or a diastolic blood pressure ≥80mmHg).

• The expanded role of SGLT2 inhibitor use in preserved and reduced heart failure ejection fraction.

• The role of finerenone (not yet reimbursed in Ireland) in individuals with diabetes and chronic kidney disease with albuminuria.

• New lipid management recommendations suggesting lower LDL goals for high-risk individuals.

Other noteworthy changes to the 2023 Standards of Care include:

• An expanded non-alcoholic fatty liver disease (NAFLD), now known as metabolic dysfunction associated steatotic liver disease (MASLD), subsection.
• Details on digital health, telehealth, and telemedicine and the benefits of these modalities of care delivery.
• The utility of point-of-care HbA1c testing for diabetes screening and diagnosis.
• Screening for food insecurity by any member of the diabetes healthcare team.
• Updates in alignment with the Management of hyperglycaemia in type 2 diabetes, 2022. A Consensus Report by the ADA and the European Association for the Study of Diabetes (EASD).
• The use of technology in older adults with diabetes.
• The use of person-first and inclusive language.
• Updates in vaccination for people with diabetes.
• Updates in Covid-19 and diabetes.

The ADA 2023 Standards of Care can be accessed here: https://diabetesjournals.org/care/issue/46/Supplement_1