Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Diabetes Care Standards Upgraded

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Diabetes Care Standards Upgraded

Article excerpt

Upgrading the standard of care for diabetes, the American Diabetes Association now recommends a stronger focus on mental health problems associated with diabetes, a lower body mass index level to qualify for bariatric surgery, and the reporting of low blood sugar levels to physicians.

On Dec. 15, the association released two important reports - "2017 Standards of Medical Care in Diabetes" and a consensus report on "Differentiation of Diabetes by Pathophysiology, Natural History and Prognosis." Both are available on the ADA website at www.diabetes.org.

"This year, the standards include critical new evidence-based additions - psycho-social care, expanded physical fitness, metabolic surgery and hypoglycemia - all of which can impact effective diabetes care," said Robert E. Ratner, the association's chief scientific and medical officer. "Together, the new standards and the differentiation report will guide health care providers and patients around the world in a multidisciplinary approach to provide a comprehensive, individualized diabetes care plan."

Any plan should be personalized, account for the whole patient and include factors that impact his or her ability to successfully manage diabetes and realize improved health outcomes, he said.

The new standards stress the importance of screening adults and youth with diabetes for distress, or what it describes as "unique emotional issues related to the burdens and worries of living with diabetes," along with depression, anxiety and eating disorders, with various situations warranting "referral to a mental health specialist."

Improvements also are needed in assessing how other illnesses impact diabetes, with the new standard recommending physical activity every 30 minutes and better assessment of how sleep patterns affect blood sugar levels.

In an important change, the report also recommends lowering requirements for metabolic surgery - bariatric surgery - to people with a body mass index as low as 30 (27.5 for Asian-Americans). Normal BMI is lower than 25. Current guidelines make bariatric surgery an option for people with Type 2 diabetes whose BMI is 35 or higher.

The standards of care now call for expanded options for hypertension medications, along with more glucose-management pathways or strategies to help people reach healthy blood sugar targets. It also recommends two specific glucose-lowering drugs - liraglutide and empagliflozin - for patients who have both diabetes and cardiovascular diseases. …

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