Diabetes technology, social determinants of health updates top ADA 2021 Standards of Care
The American Diabetes Association published its 2021 Standards of Care, with new evidence-based updates ranging from diabetes technology and self-management education to socioeconomic disparities and COVID-19 vaccine recommendations.
The 2021 Standards of Medical Care in Diabetes provides the latest in comprehensive, evidence-based recommendations for the diagnosis and treatment of children and adults with type 1, type 2 or gestational diabetes; strategies for the prevention or delay of type 2 diabetes; and therapeutic approaches that can reduce complications, mitigate cardiovascular and renal risk, and improve health outcomes.
“Our incorporation of what was learned this year while treating patients virtually due to COVID-19 is one of the biggest changes,” Robert Gabbay, MD, chief scientific and medical officer at the ADA, told Healio. “We now recommend assessment of glycemic status can be done using HbA1c or other glycemic measurement, rather than just by HbA1c as we have in years past.”
The 2021 update includes evidence from several large clinical trials and several new recommendations:
The Standards now states that social determinants of health are essential intervention targets to achieve health equity among people with diabetes, after a new scientific review from the ADA recommended large-scale implementation of effective interventions that target social determinants directly.
The section on CVD risk management was revised to include evolving evidence for diabetes treatment for people also managing chronic kidney disease and heart failure; data from CAROLINA, PIONEER-6, CREDENCE and DAPA-HF were incorporated into the updated Standards.
“Blinded” continuous glucose monitoring is now referred to as “professional CGM,” which is clinic-based and can include real-time devices. The updated Standards now recommend CGM as “useful” for people with diabetes on multiple daily injection therapy, insulin pump therapy and other forms of insulin therapy “not defined by type of diabetes or age.”
Recommendations regarding barriers to diabetes self-management and education and support, or DSMES, have been added. “The four critical times DSMES needs should be evaluated have been revised based on the consensus report,” the statement notes.
More information has been added to the discussion of each recommended vaccine for people with diabetes, including important considerations related to COVID-19.
“We encourage providers to take advantage of the various forms that the Standards of Care comes in,” Boris Draznin, MD, chair of the Professional Practice Committee for the ADA, told Healio. “Our Primary Care Advisory Group distills the full Standards of Care each year into a more digestible Abridged Standards of Care that is published online in Clinical Diabetes simultaneously with the Standards of Care. We also have created a mobile app that contains the full Standards of Care, as well as interactive tools derived from our treatment algorithms. We offer a webcast highlighting the changes you see this year which is available for free with continuing education credit, as well as a slide deck that can be used for presentations and education. We want to make accessing the Standards as easy as possible to help improve the lives of people effected by diabetes.”
The ADA now updates and revises the online version of the Standards of Care throughout the year, with annotations for new evidence or regulatory changes that merit immediate incorporation. The online version of the Standards of Care will include any research updates or policy changes that are approved throughout 2021. Updates to the Standards of Care are established and revised by the ADA’s Professional Practice Committee, a multidisciplinary team of 16 U.S. experts in the field of diabetes care, including physicians, diabetes care and education specialists, registered dietitians and others whose experience includes adult and pediatric endocrinology, epidemiology, public health, lipid research, hypertension, preconception planning and pregnancy care.
Two designated representatives of the American College of Cardiology (ACC) reviewed and provided feedback on the “Cardiovascular Disease and Risk Management” section, and this section received endorsement from ACC.
The online version of the Standards of Care will continue to be annotated in real time with necessary updates if new evidence or regulatory changes merit immediate incorporation through the living Standards of Care process. The webcast with continuing education credit and a full slide deck can be found on DiabetesPro.
The Standards of Care is available online and is published as a supplement to the January issue of Diabetes Care.
ADA Standards of Medical Care in Diabetes — 2021. Available at: https://care.diabetesjournals.org/content/44/Supplement_1. Accessed: Dec. 9, 2021.