The American Diabetes Association (ADA) on Monday released new standards for diabetes care for 2023, which includes 100 new or revised recommendations that address changes in technology, medication, and social factors that could contribute to the disease.

ADA updates diabetes care standards

ADA's Standards of Care for diabetes has been updated annually since 1989. In the 2023 version, more than 100 new or revised recommendations were added to the document's 17 sections. These updates highlight new advances in diabetes management, as well as how social determinants of health can influence the condition.

The standards, which were updated by a multidisciplinary team of 20 experts, include changes to several different areas of diabetes care, such as:

1. Weight management

In the new standards, the recommended weight loss for patients with diabetes has been increased to 15% of their body weight instead of 5%.

According to Robert Gabbay, chief science and medical officer for ADA, new tools, especially more effective weight-loss medications, will allow patients with diabetes to have more control over their weight. "We have better tools to achieve those goals, making them realistic," he said.

Other guidelines about diet and exercise, such as eating a well-balanced diet and eating fewer processed foods and added sugar, remain the same. "Recommendations around lifestyle haven't changed and they're still important," Gabbay said.

2. Cardiovascular and kidney disease prevention

Diabetes is a leading cause of heart disease, and heart disease is also leading cause of death for patients with diabetes.

The new standards, which align with those from the American College of Cardiology, recommend a lower target of less than 130 over 80 for blood pressure. Patients without heart disease are now recommended to have a measurement of 70 instead of 100 for LDL cholesterol. For patients with heart disease, LDL cholesterol should be at 55 instead of 70.

According to Gabbay, statins can help patients cut their cholesterol levels and other medications can reduce blood pressure to meet the standards' targets. "There are a number of studies demonstrating that even lower goals result in better outcomes for people with diabetes," he said.

In addition, the guidelines also advocate for more aggressive treatment to prevent chronic kidney disease since diabetes is a leading cause of this condition.

3. Amputation risks

The new standards call for more careful screening for foot ulcers and peripheral arterial disease, two conditions that can lead to amputations among patients with diabetes.

According to Gabbay, the rate of amputations has gotten worse instead of better, particularly among Black Americans with diabetes, who are three to four times more likely to have a limb amputated than white Americans with diabetes.

4. Healthy sleep habits

In the new standards, doctors are encouraged to counsel their patients about healthy sleep habits and identify any patients with sleep issues. Many patients with diabetes also have sleep apnea, a condition that leads them to stop breathing briefly during sleep.

Treating diabetes, particularly with weight management, can improve a patient's sleep apnea, which can then also help them control their diabetes.

In general, patients with diabetes should try to get enough high-quality sleep to improve their health. "Not too much and not too little," Gabbay said. "Both are associated with poorer outcomes when it comes to diabetes."

5. Social factors

According to Gabbay, everyone with diabetes should be screened for issues that could affect their ability to manage their condition, such as food insecurity, employment, and more.

"We want the entire diabetes health care team to participate in asking people about food, but also other things," said Nuha El Sayed, chair of ADA's Professional Practice Committee who helped write the new standards. "Did they lose their job? Do they live in a safe neighborhood – before we tell them to exercise."

Studies have also shown that community health workers, particularly in underserved and disadvantaged communities, can help patients with diabetes adhere to medication and lifestyle changes more readily.

6. Access to technology

The new guidelines recommend all patients be offered the latest technology, including automated insulin delivery devices and glucose pumps.

According to Gabbay, doctors often fail to recommend high-tech treatments to older patients. Black Americans and other people of color also often have less access to more advanced technologies for diabetes.

To improve this situation, ADA has created a technology access program. "Everyone should have access to the technologies that can help them thrive with their diabetes," Gabbay said.

"ADA's mission is to prevent and cure diabetes, a chronic illness that requires continuous medical care, and the release of ADA's Standards of Care is a critical part of that mission," said Chuck Henderson, ADA's CEO. "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." (Weintraub, USA Today, 12/12; American Diabetes Association press release, 12/12)