The American Diabetes Association (ADA) just released its 2018 Standards of Medical Care in Diabetes. Since 1989, the organization has provided annual updates to keep current with research, technology, and treatments for both Type 1 and Type 2 Diabetes. The latest changes reflect an emerging reality for diabetes care in the twenty-first century: data-driven technology is increasingly integral in the management of the disease.
The 2018 guide recognizes the enormous benefit of emerging technologies, such as continuous glucose monitoring (CGM) systems and automated insulin delivery systems. It provides more extensive-than-ever guidelines to providers on these technologies, and it expands recommendations for the use of such systems. For instance, the ADA now recommends the use of CGM for all adults with Type 1 Diabetes who are not achieving glycemic targets. (Previously, the technology was only recommended to persons 25 and above.) The ADA has also added text to inform providers about a recently approved intermittent (“flash”) CGM device and about CGM devices that no longer require manual confirmation of blood glucose for treatment decisions.
There are suggestions for using analytics from devices to tailor and individualize treatment decisions. For instance, physicians are encouraged to use data to assess an individual’s hypoglycemic and hyperglycemic risks, and, in turn, adjust A1C goals. In addition to recognizing the value of such developments, the ADA is mindful that many patients today feel as though they are being scrutinized and/or reduced to a pile of statistics. Consequently, the 2018 manual includes extensive recommendations for providers to humanize diabetes care. For instance, the manual encourages providers to use more sensitive language when interacting with patients. Rather than using words that convey judgment (“noncompliant,” for instance), providers are encouraged to use words that suggest collaboration between patient and provider.
Providers should also tailor treatment to social context, according to the ADA. New guidelines direct providers to assess factors such as food insecurity, housing insecurity, and financial instability, and to apply this information to treatment decisions. Where available, providers should refer patients in need to community resources.
The ADA’s efforts to integrate more holistic approaches in diabetes care are also evidenced by new recommendations for providers to routinely monitor for “diabetes distress” (psychological burden related to living with the chronic disease), as well as by new recommendations to simplify complex regimens for older adults. The 2018 manual outlines “Advocacy Position Statements,” which encourage providers to take a more active role in reducing discrimination against persons with diabetes. These statements equip providers with tools to better educate schools, employers, policymakers, and licensing agencies about the disease.
Beginning in 2018, the ADA will routinely update its Standards throughout the year in order to accommodate the rapid pace of research and technological developments.
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