New Diabetes Standards Emphasize Weight Loss, Update Medication Guidance

Notable updates to the American Diabetes Association (ADA) new Standards of Care in Diabetes─2023¹ include emphasis on higher weight loss.

The Standards also stress broad consideration of social determinants of health in guiding the design and delivery of diabetes care. “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 color disproportionately impacted by the disease. This guidance will ensure health care teams, clinicians and researchers treat the whole person,” ADA CEO Chuck Henderson said in a news release.²

Also notable Is new hypertension diagnosis cut-offs: hypertension is now defined as a systolic blood pressure ≥130 mmHg or a diastolic blood pressure ≥80 mmHg). New lipid management recommendations also suggest lower LDL levels for high-risk individuals.

The Standards of Care also recommend treatment with a sodium–glucose cotransporter 2 inhibitor in individuals with type 2 diabetes and established heart failure with either preserved or reduced ejection fraction to improve symptoms, physical limitations, and quality of life.

The Standards added finerenone in the treatment of individuals with type 2 diabetes and chronic kidney disease with albuminuria treated with maximum tolerated doses of ACE inhibitor or angiotensin receptor blocker.

In addition, the Standards of Care now include inclisiran, an siRNA directed against PCSK9, as a new FDA-approved cholesterol-lowering therapy.

A both small and larger weight losses should be considered as treatment goals on a case-by-case basis, larger (10% or more) weight loss may have disease-modifying effects, including diabetes remission, and may improve long-term cardiovascular outcomes, the Standards of Care said.

Dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonist (tirzepatide) was also added as a glucose-lowering option with the potential for weight loss.

“Evidence-based recommendations drive better care for all people with diabetes, including vulnerable communities and those at high risk. ADA’s Standards of Care are the gold standard for diabetes care and prevention that allows clinicians around the world to remain abreast of the rapidly changing healthcare landscape,” said Dr. Robert Gabbay, chief scientific and medical officer for the ADA.

References

1. ElSayhed, N., Aleppo, G., et al. Standards of Care in Diabetes - 2023. Diabetes Care. December 2022. https://diabetesjournals.org/care/issue/46/Supplement_1

2. American Diabetes Association releases 2023 Standards of Care in Diabetes guide for prevention, diagnosis, and treatment for people living with diabetes. News release. ADA. December 12, 2022. Accessed December 16, 2022. https://diabetes.org/newsroom/press-releases/2022/american-diabetes-association-2023-standards-care-diabetes-guide-for-prevention-diagnosis-treatment-people-living-with-diabetes