Highlights of the 2015 Diabetes Medical Care Standards

 

Do you wonder where your diabetes goals came from? Have you thought about how your doctor and your healthcare team know what tests to do and when to do them? Do you know how the results of those tests help you manage your diabetes? These goals and tests don’t just happen. Every year, a dedicated group of diabetes clinicians and researchers convene to review, revise and develop what are called “Diabetes Medical Care Standards.” These guidelines are issued by the American Diabetes Association and are published each January in a supplement of the journal called Diabetes Care. These standards of care address everything from target A1C goals to foot care to managing diabetes during pregnancy to diabetes education. Talk about being comprehensive!

Who uses these standards? Your doctor and other members of your healthcare team should be familiar with and using them. Researchers and insurance companies use them, too. And many people with diabetes who take a keen interest in their diabetes management read them as well. If you’re interested in taking a look yourself, you’ll find them here:

http://care.diabetesjournals.org/content/38/Supplement_1

2015 Highlights

The standards can seem overwhelming, and you might be wondering how your doctor could ever keep up with them. Well, not everything changes from year to year. But there are some important changes and additions that you should know about. So, what’s new for 2015?

• Pre-meal blood glucose goal: For quite a while, the blood glucose goal before each meal has ranged from 70 to 130 mg/dl. This year there’s a change: the pre-meal glucose target for most people with diabetes is now 80 to 130 mg/dl. The change “better reflects new data comparing actual average glucose levels with A1C targets.” What does this mean for you? Talk with your doctor. Find out what your own glucose goals are and ask if yours might change based on this new target range.

• Blood pressure goal: Based on newer research, the diastolic (bottom number) blood pressure goal has changed from 80 to 90 mm Hg for most people with diabetes and high blood pressure. Again, some people may still have a target of 80, so be sure to ask your doctor about your own blood pressure goal.

• Cholesterol: Your doctor should now consider your risk level for heart disease and possibly prescribe a medication called a statin based on that risk level, rather than basing that decision on your LDL, or bad, cholesterol level. People with diabetes have significant heart disease risk, so the belief is that most people with diabetes probably need to take a statin.

• BMI screening threshold for Asian-Americans: If you or a loved one is Asian-American, it’s important to note that your diabetes risk is increased at a lower body mass index (BMI) compared to the general population. In other words, you should now be screened for prediabetes or type 2 diabetes if your BMI is 23; a BMI of 25 is considered to be overweight.

• Physical activity: We all know about the importance of regular physical activity. But the 2015 standards encourage people with diabetes to “limit the amount of time they spend being sedentary” by breaking up the time (more than 90 minutes) spent sitting. So, if you sit at a desk all day, make sure you get up and move after at least 90 minutes. Don’t forget resistance training, too, which includes using hand weights, resistance bands or weight machines. Aim to do resistance training twice each week.

• Smoking: Trying to quit smoking and hoping that those new e-cigarettes might help? Sorry. E-cigarettes, or electronic cigarettes, are battery-operated devices that contain liquid nicotine. These e-cigarettes don’t burn and produce smoke. Instead, they produce a vapor. While they may be less harmful in general than regular cigarettes, there’s no evidence that they’re healthier to smoke or that they can help with smoking cessation.

• Pneumonia vaccine: If you’re 65 years of age or older, you need to get a pneumonia vaccine. This vaccine is now given in two separate shots – a Prevnar shot followed 12 months later by a Pneumovax shot.

It’s a good idea to check with your doctor about these new recommendations and find out if your goals have changed, if you should start taking a statin, or if anything else from this list might apply to you. Be proactive and make sure you’re receiving the best diabetes care possible.