Standards of Medical Care in Diabetes, 2017: What’s New?

Every January, the American Diabetes Associations issues its Standards of Medical Care in Diabetes. These are guidelines that help your healthcare team provide you with the best diabetes care, and help you better manage your own diabetes. What’s new or different for 2017?  Let’s take a look.

Promoting Health and Reducing Disparities in Populations

This section is called “Strategies for Improving Care,” and is about the importance of “patient-centered care,” or care that is respectful of your own preferences, needs, and values.

• What it means for you:
  • When providing care, your healthcare team needs to be aware of possible social and lifestyle issues, like food insecurity (access to enough food), housing issues, and financial barriers (can’t afford health insurance). Your healthcare team should take all these into consideration when developing your treatment plan.
  • When needed, you should be referred to support services within your community.
  • You might also get diabetes self-management support from community health workers or coaches, especially if you live in an underserved community.

Classification and Diagnosis of Diabetes

In type 1 diabetes, blood glucose and A1C levels increase before the symptoms of type 1 diabetes appear. The American Diabetes Association recognizes three different stages of type 1 diabetes: stage 1, stage 2, and stage 3.

• What it means for you:
  • If you have or are at risk for type 1 diabetes, your healthcare provider might be able to determine what stage of type 1 you have. This helps decide the best treatment options for you.
  • Research is being done to identify treatments for stage 1 or 2 of type 1 diabetes.

Comprehensive Medical Evaluation and Assessment of Comorbidities

This section includes guidelines for provider-patient communication, screening for diabetes distress, depression and other psychological issues, and the importance of screening for other conditions (comorbidities: the presence of one or more additional diseases).

• What it means for you:
  • Healthcare providers are encouraged to establish a cooperative relationship with their patients, take the time to actively listen, address barriers to care, and be nonjudgmental in order to encourage better communication.
  • If you’re having difficulty coping with diabetes, are feeling depressed or anxious, or are struggling with your eating, your healthcare provider should assess and address these issues with you.

Lifestyle Management

This section is about the importance of diabetes self-management education (DSME), healthy eating, physical activity, stopping smoking, and getting help for mental health issues.

• What it means for you:
  • You should have an eating plan that is designed for your needs and preferences. On a flexible insulin regimen? Then you are encouraged to count your carbs, although for some people, counting fat and protein grams might be more effective.
  • There is still no “ADA diet.” The ADA does not recommend a set percentage of calories from carbohydrate, protein and fat.
  • If you’re an adult with type 2 diabetes, you should avoid sitting for long periods of time. For every 30 minutes you sit, try to be active for at least 3 minutes. This will help improve your blood sugar control.
  • Let your healthcare provider know if you’re feeling depressed or anxious, or if you think you have an eating disorder. Your provider will help you get the help and care that you need.

Glycemic Targets

The best way for you and your healthcare provider to know how your diabetes is doing is through self-monitoring of blood glucose (SMBG) and A1C measurements. Continuous glucose monitoring (CGM) can also be helpful for those with type 1 diabetes, and some people with type 2 diabetes. These results help your healthcare provider develop the best diabetes treatment plan for you.

• What it means for you:
  • Low blood sugar (hypoglycemia) makes it very difficult for you to effectively manage your type 1 or type 2 diabetes. A low blood sugar means you need to take a fast-acting carbohydrate, and consider talking to your healthcare provider about adjusting your diabetes medication.

Treatment Options

There are some new treatment options for people who have diabetes and who are obese, have high blood pressure, and/or have heart disease.

• What it means for you:
  • Metabolic surgery (formerly called bariatric surgery) is now approved for certain people with type 2 diabetes.
  • For those with type 2 diabetes who take insulin, more “pathways” are available to help them get to their A1C and blood sugar goals.
  • There are more medications to help manage high blood pressure.
  • For people who have heart disease, there are drugs to lower blood sugar that might be helpful in treating heart disease.
  • Metformin, a first-line choice of treatment for those with type 2 diabetes, is linked with vitamin B12 deficiency. So your provider should check your B12 levels periodically, and recommend a supplement if they’re low
  • Healthcare providers are now provided with medication costs – specifically, the average monthly cost of various diabetes medications. This is to help your provider better address concerns about the cost of your medications.

Diabetes discoveries and treatments are constantly changing. The Standards of Medical Care help your healthcare team stay better equipped, more up to date and better able to care for you.