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ADA STANDARDS OF CARE IN DIABETES

Date: 02/03/23

The American Diabetes Association (ADA) released its annual Standards of Care in Diabetes in December 2022. For reference, we’ve published a summary of the revisions. Weight loss, sleep health, social determinants of health, hypertension, chronic kidney disease, and the expanded role of SGLT2 inhibitor use are key topics. Please refer to Meridian’s Preferred Drug List for details on medications.

Summary of revisions

  • Emphasis on supporting more significant weight loss (up to 15%) based on the efficacy of and access to newer medications when appropriate
  • Consider screening for sleep health in people with diabetes, including symptoms of sleep disorders, disruptions to sleep due to diabetes symptoms or management needs, and worries about sleep. Refer to sleep medicine or a qualified behavioral health professional as indicated
  • Nutrition, physical activity, and behavioral therapy to achieve and maintain ≥5% weight loss are recommended for most people with Type 2 Diabetes and who are overweight or obese
  • When choosing glucose-lowering medications for people with Type 2 diabetes, who are overweight or obese, consider the medication’s effect on weight
  • Broad consideration of social determinants of health in guiding the design and delivery of care
  • New hypertension diagnosis cut-offs (hypertension is now defined as a systolic blood pressure ≥130 mmHg or a diastolic blood  pressure ≥80 mmHg)
  • The expanded role of SGLT2 inhibitor use in preserved and reduced heart failure ejection fraction. The initiation can be considered in people with Type 2 Diabetes and Cardio Vascular Disease independent of the current A1C or A1C goal or metformin therapy. The SGLT2 inhibitors on Meridian’s Preferred Drug List are canagliflozin (Invokana®), dapagliflozin (Farxiga®), and empagliflozin (Jardiance®)
  • For people with Type 2 Diabetes and chronic kidney disease with albuminuria treated with the maximum tolerated doses of ACE inhibitor or angiotensin receptor blocker, the addition of finerenone (Kerendia) is recommended to improve cardiovascular outcomes and reduce the risk of chronic kidney disease progression. Kerendia is preferred with prior authorization
  • New lipid management recommendations suggesting lower LDL goals for high-risk individuals (LDL<55mg/dL)

 

References
1. American Diabetes Association Releases 2023 Standards of Care in Diabetes to Guide Prevention, Diagnosis, and Treatment for People Living with Diabetes. Accessed January 12, 2023.

2. Diabetes Care December 2022, Vol.46, S158-S190. Accessed January 13, 2023.