New recommendations to screen for heart failure, peripheral arterial disease (PAD), and type 1 diabetes risk, along with new obesity management guidance, are among many updates to the American Diabetes Association's (ADA's) Standards of Care for 2024.
"The Standards of Care are essentially the global guidelines for the care of individuals with diabetes and those at risk," ADA chief scientific and medical officer Robert Gabbay, MD, PhD, said during a briefing announcing the new Standards.
The document was developed via a scientific literature review by the ADA's Professional Practice Committee. The panel comprises 21 professionals, including physicians from many specialties, nurse practitioners, certified diabetes care and education specialists, dieticians, and pharmacists. The chair is Nuha A. El Sayed, MD, ADA's senior vice president of healthcare improvement.
Specific sections of the 2024 document have been endorsed by the American College of Cardiology, the American Society of Bone and Mineral Research, and the Obesity Society. It was published on December 11, 2023, as a supplement in Diabetes Care.
An introductory section summarizing the changes for 2024 spans six pages. Those addressed during the briefing included the following:
Heart Failure Screening: Two new recommendations have been added to include screening of adults with diabetes for asymptomatic heart failure by measuring natriuretic peptide levels to facilitate the prevention or progression to symptomatic stages of heart failure.
"This is a really important and exciting area. We know that people with type 2 diabetes in particular are at high risk for heart failure," Dr Gabbay said, adding that these recommendations "are to really more aggressively screen those at high risk for heart failure with a simple blood test and, based on those values, then be able to move on to further evaluation and echocardiography, for example. The recommendations are really to screen a broad number of individuals with type 2 diabetes because many are at risk, [particularly] those without symptoms."
PAD Screening: A new strong recommendation is to screen for PAD with ankle-brachial index testing in asymptomatic people with diabetes who are aged ≥ 50 years and have microvascular disease in any location, foot complications, or any end-organ damage from diabetes. The document also advises consideration of PAD screening for all individuals who have had diabetes for ≥ 10 years.
Gabbay commented, "We know that amputation rates are rising, unlike many other complications. We know that there are incredible health disparities. Blacks are two to four times more likely than Whites to have an amputation."
El Sayed added, "Many patients don't show the common symptoms of peripheral arterial disease. Screening is the most important way to find out if they have it or not because it can be a very devastating disease."
Type 1 Diabetes Screening: This involves several new recommendations, including a framework for investigating suspected type 1 diabetes in newly diagnosed adults using islet autoantibody tests and diagnostic criteria for preclinical stages based on the recent approval of teplizumab for delaying the onset of type 1 diabetes.
"Screening and capturing disease earlier so that we can intervene is really an important consideration here. That includes screening for type 1 diabetes and thinking about therapeutic options to delay the development of frank type 1 diabetes," Gabbay said.
Screening first-degree relatives of people with type 1 diabetes is a high priority because they're at an elevated risk, he added.
Obesity Management: New recommendations here include the use of anthropomorphic measurements beyond body mass index to include waist circumference and waist:hip ratio and individual assessment of body fat mass and distribution.
Individualization of obesity management including behavioral, pharmacologic, and surgical approaches is encouraged. The use of a glucagon-like peptide-1 (GLP-1) receptor agonist or a dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist with greater weight loss efficacy is preferred for obesity management in people with diabetes.
"Obesity management is one of the biggest changes over this last year," Gabbay commented.
Other New Recommendations: Among the many other revisions in the 2024 document are new recommendations about regular evaluation and treatment for bone health, assessment of disability and guidance for referral, and alignment of guidance for liver disease screening and management with those of other professional societies. Regarding the last item, Gabbay noted, "I don't think it's gotten the attention it deserves. Diabetes and obesity are becoming the leading causes of liver disease."
Clinicians can also download the Standards of Care app on their smartphones. "That can be really helpful when questions come up since you can't remember everything in there. Here you can look it up in a matter of seconds," Gabbay said.
El Sayed added that asking patients about their priorities is also important. "If they aren't brought up during the visit, it's unlikely to be as fruitful as it should be."
El Sayed has no disclosures. Gabbay serves as a consultant and/or advisor for HealthReveal, Lark Technologies, Onduo, StartUp Health, Sweetech, and Vida Health.
Miriam E. Tucker is a freelance journalist based in the Washington DC area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. She is on X (formerly known as Twitter) @MiriamETucker.
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