Chances are you know someone with diabetes. Today, the number of people with diabetes is higher than it has ever been — and it’s not just your grandparents. It’s increasing in higher rates at younger ages and disproportionally among Black and Hispanic/Latino adults.
In 2021, more than 100,000 Americans died from diabetes, marking the second consecutive year for that grim milestone. This has spurred many in the health care community and the U.S. government to mobilize more aggressive tactics that focus not only on treatment but also prevention, cures and improved care for vulnerable communities.
2023 updates to standards of care in diabetes
In December 2022, the American Diabetes Association (ADA) published updates to its standards of care with almost 100 new or revised recommendations that reflect changes in technology, improved medications and a deeper understanding of the social factors that contribute to disease and diabetes control.
The standards of care include recommendations for children and adolescents, adults and older adults with diabetes, as well as management of diabetes during pregnancy.
The authors of the new standards hope these will be used by health care professionals, diabetes care specialists, policymakers and the diabetes community at-large as the go-to source for diabetes care.
“The goal of these guidelines is to reduce the burden of the disease,” said James Speed, MD, an endocrinologist at Banner Health in Colorado. “The changes focus not only on things like weight control and cholesterol management, but it also addresses racial disparities — highlighting the disparities in care and outcomes.”
6 things to know about the new standards of care
Let’s face it, oftentimes health information can be confusing, especially when you have to read through and try to understand a 300-page document put together by medical experts who may not speak in general terms.
We’re here to help. Dr. Speed shared important things to know regarding the ADA’s new Standards of Care so you are well-informed and can be a proactive participant in your care.
1. Improved weight management
Obesity is still a risk factor for type 2 diabetes and can contribute to a number of other health complications, such as high blood pressure and high cholesterol.
Guidelines regarding diet and exercise remain the same when it comes to maintaining good health, but new tools will allow you to have more control over your weight.
Previously the ADA stated that taking off just 5% of your body weight can have significant benefits on your health. New recommendations are 15% of body weight. This can be better achieved now, thanks to more effective weight loss medications and weight loss tools that help you better manage your glucose levels.
Therapeutic drugs like Mounjaro, which was approved this year to treat type 2 diabetes, have shown remarkable weight loss effects. It has been shown to help you feel better and reduce your risk of developing other problems.
While these medications are effective, Dr. Speed said healthy eating is still a cornerstone of healthy living, with or without diabetes.
“People sometimes look for quick fixes with medications,” he said. “These therapeutic drugs work, but it’s best to do along with lifestyle habits, like eating well and getting exercise.”
2. Greater access to technology
New guidelines recommend that everyone be offered and educated on the latest technologies, which include the use of telehealth and telemedicine, and continuous glucose monitors (CGM) like Libre and Dexcom. Research has shown that people who are given technologies like CGMs often describe them as “transformative” and “game changers.”
The challenge is that the elderly, Black Americans and other people of color may have less access to and understanding of these advanced technologies. In addition, insurance coverage can often lag behind as well as patient interest and willingness to use something different.
To address these challenges, the ADA has created a technology access program to boost equity and compliance. As well, some Medicaid and Medicare programs are now covering CGMs.
“Everyone should have access to technologies and care,” Dr. Speed said. “These have truly been game-changers in diabetes management, especially with preventing severe low blood sugar emergencies.”
3. Healthy sleep habits
New guidance includes new recommendations on lifestyle factors, including sleep. Getting proper rest is important for everyone, but especially when you have diabetes. Poor sleep can negatively affect every area of managing your diabetes properly, including how much you eat, what you eat and how your body responds to insulin.
Disrupted sleep and sleep disorders, including sleep apnea, are common among people with diabetes. In addition, sleep disorders are a risk factor for developing type 2 diabetes as well as obesity, depression and heart disease.
The new recommendation suggests health care providers screen for sleep health in people with diabetes and those who may be at risk and refer them to a sleep medicine and/or qualified specialist for help.
4. Heart disease and kidney disease prevention
Diabetes is a strong risk factor not only for cardiovascular disease but also for the development of chronic kidney disease (CKD). Over time, this can lead to kidney failure and death.
In line with the American College of Cardiology, the new guidelines include a lower target for blood pressure of less than 130 over 80. The authors also recommend LDL cholesterol (the bad kind) should be 70 for people without heart disease and 55 for those with heart disease.
“It’s important to remember that diabetes isn’t glucose control only,” Dr. Speed said. “Cholesterol and blood pressure are of equal importance, especially when it comes to developing cardiovascular disease and CKD.”
The guidelines also call for more aggressive treatment to prevent CKD from progressing into end-stage renal disease.
5. Amputation and retinopathy prevention
In addition to heart disease and kidney disease, diabetes can put you at greater risk for amputations and diabetic retinopathy, an eye condition that can cause blurred vision and blindness. Retinopathy most commonly occurs after the onset of puberty and after having diabetes for five to 10 years.
New guidelines call for more careful screenings for foot ulcers and peripheral arterial disease (PAD) and comprehensive eye exams for adults and children.
“Children should start to get in the habit of regular eye exams early on,” Dr. Speed said. “For adults, glucose control is very important to focus on when it comes to retinopathy.”
[Also read “How to Keep Your Feet Healthy When You Have Diabetes.”]
6. Improvements on health inequities
Psychosocial (environmental, family, behavioral or emotional) factors and social problems can affect a person’s ability to properly manage their diabetes. Racial and ethnic minorities with lower socioeconomic status have historically had higher rates of illness and death. As well, food insecurity, housing insecurity and financial barriers can also lead to poorer care and diabetes management.
New recommendations include screenings to look for problems that are likely to get in the way of good diabetes management and address them with proper support from community workers or health coaches.
“A lot this is being done through community health organizations, even religious organizations, to reach these underserved communities,” Dr. Speed said. “These organizations typically are from, or have a unique understanding of, the community served and can provide a shared understanding of the disease and offset any stigma there may be.”
The 2023 standards of care released by the American Diabetes Association outlined new standards of care that address weight management, new technologies, lifestyle factors and improvements in health inequities.
Within the 300-page document, there are many more recommendations that may be of interest to you or a loved one with diabetes. We encourage you to speak with your health care provider or a diabetes educator to answer any questions or concerns or further education on the recommendations.
To find a Banner Health specialist near you, visit bannerhealth.com.