2024 AMERICAN DIABETES ASSOCIATION ANNUAL STANDARDS OF CARE UPDATE
Date: 01/29/24
The American Diabetes Association (ADA) published their annual Standards of Care update in January. This is a summary of the major revisions, please refer to the complete Standards of Care for all guidelines.
Comprehensive Medical Evaluation and Assessment of Comorbidities
The standards include recommendations for bone health for people with diabetes:
- Bone health should be assessed as part of routine care for older adults with diabetes according to the risk factors and comorbidities.
- Adults ≥65 years old and younger adults with multiple risk factors should have bone mineral density monitored with dual energy x-ray absorptiometry every 2-3 years.
- Consider impact on bone health when selecting pharmacological agents to lower blood glucose levels. Agents such as the thiazolidinediones (TZD’s) are known to cause decreases in bone density.
- Prioritize use of pharmacological agents that have a low risk of hypoglycemia to reduce the risk of falls.
- Advise patients regarding their calcium and vitamin D intake.
- Consider antiresorptive agents for those with a T score <2.0 or who have had fractures.
Disability
- A disability assessment should be performed at every visit and provider referrals made as appropriate, (physical therapy, occupational therapy, ophthalmology, etc.).
Obesity and Weight Management
- In addition to BMI calculation, additional body fat distribution measures should also be performed such as waist circumference or waist to hip ratio.
Cardiovascular Disease and Risk Management
- Consider screening people with diabetes for heart failure and peripheral arterial disease.
- People with established diabetes and heart failure (either preserved or reduced rejection fraction) should be prescribed a sodium glucose co-transport inhibitor (SGLTi). Invokana®, Fraxiga®, and Jardiance® preferred on the Meridian PDL.
Older Adults
- Older adults who are healthy with few and stable chronic disease states and intact cognitive function should have an A1C goal (<7.0-7.5%).
- Older adults with intermediate or complex health should have individualized, less stringent goals (<8.0%).
- Older adults with poor or very complex health should have less glycemic control. Clinicians should concentrate less on goals and more on avoidance of hypoglycemia.