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HelixTalk Episode #94 - The Sweet Sweet Taste of Annually Updated Guidelines: 2019 Standards of Diabetes Care

Date posted: April 16, 2019, 6:00 am

In this episode, we discuss the changes made in the American Diabetes Association’s 2019 Standards of Diabetes Care guideline as well as updates in therapy recommendations per ADA and ESDA consensus statement published in Fall 2018.

 

Key Concepts

  1. The diagnosis of diabetes can be made by running two different tests from the same blood sample.
  2. Evidence for self-monitoring blood glucose (SMBG) testing for patients with diabetes who are not on intensive insulin therapy is less clear - it is part of the new section in the guidelines called Diabetes Technologies. 
  3. The pathway to injectable medication therapy is revised to prioritize use of a GLP-1 agonist over insulin for those needing an agent with better efficacy. 
  4. With alignment to the ADA-ESDA consensus report published in October 2018, the treatment decision tree now delineates recommendations based on ASCVD risk, chronic kidney disease, heart failure, hypoglycemia risk, body weight effects, and cost.
  5. Updates in comorbidity treatment and evaluation include: aspirin use for primary prevention in patients with diabetes is less clear, blood pressure goals should consider underlying ASCVD risk, routine foot exam every 3 months should be reserved for high ulcer risk patients, and gabapentin merits its place in the treatment in diabetic peripheral neuropathy along with pregabalin and duloxetine.

References