American Diabetes Association® Issues First Updates to 2018 Standards of Medical Care in Diabetes

ARLINGTON, Va. (April 11, 2018) — The American Diabetes Association’s (ADA’s) Standards of Medical Care in Diabetes (Standards of Care) provide the latest in comprehensive, evidence-based recommendations for the diagnosis and treatment of children and adults with type 1, type 2 or gestational diabetes; strategies to improve the prevention or delay of type 2 diabetes; and therapeutic approaches that reduce complications and positively affect health outcomes. New this year, the ADA is updating and revising the online version of the Standards of Care throughout the year with annotations for new evidence or regulatory changes that merit immediate incorporation.

Today, the ADA revised its Standards of Care to include two important updates:

A revised definition of hypoglycemia (Sections 6 and 14): The December 2017 issue of Diabetes Care featured a Consensus Report from the ADA and others in the diabetes community on clinically meaningful outcome measures beyond A1C for type 1 diabetes, which categorized hypoglycemia into three levels. The ADA has updated Section 6 - Glycemic Targets and Section 14 - Diabetes Care in the Hospital of the 2018 Standards of Care to align with the hypoglycemia definitions in the Consensus Report.
The addition of two new, FDA-approved drugs (Section 8): In December 2017, the U.S. Food and Drug Administration (FDA) approved the GLP-1 receptor agonist semaglutide and the SGLT2 inhibitor ertugliflozin as adjuncts to diet and exercise to improve glycemic control in adults with type 2 diabetes. These medications have been added to Section 8 - Pharmacologic Approaches to Glycemic Treatment.
The complete Standards of Care was published December 8, 2017, and is available online.

“With the rapid pace that information becomes available, releasing new recommendations on an annual basis is no longer sufficient,” said ADA’s Chief Scientific, Medical and Mission Officer William T. Cefalu, MD. “Now that the Standards of Care will be updated throughout the year, clinicians, patients, researchers, payers and others interested in diabetes care will have the latest information at their fingertips whenever they need it. Ensuring timely availability and access to this information is critical to improving patient care and outcomes.”

The Standards of Care are established and revised annually by the ADA’s Professional Practice Committee (PPC). The committee is a multidisciplinary team of 12 leading U.S. experts in the field of diabetes care, and includes physicians, diabetes educators, registered dietitians and others whose experience includes adult and pediatric endocrinology, epidemiology, public health, lipid research, hypertension, preconception planning and pregnancy care. For the 2018 Standards of Care, two designated representatives from the American College of Cardiology reviewed and provided feedback for the PPC’s recommendations for cardiovascular disease and risk management. Members of the committee must disclose potential conflicts of interest with industry and/or relevant organizations; these disclosures are available on page S154 of the 2018 Standards of Care.

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I’m curious about some of the recommendations to reverse hypo unawareness in Chapter 6, copied below. The ADA seems to be saying to strictly avoid low BG of less than 54 mg/dl for several weeks after each excursion below 54 that lasts for at least 20 minutes. in order to partially reverse hypo unawareness.

Just wondering if anybody has done this and have they had success in reversing hypo unawareness that quickly? I had understood it would be a long term project, like 6 + months of avoiding lows, to try to reverse hypo unawareness.

  • “Insulin-treated patients with hypoglycemia unawareness or an episode of clinically significant hypoglycemia should be advised to raise their glycemic targets to strictly avoid hypoglycemia for at least several weeks in order to partially reverse hypoglycemia unawareness and reduce risk of future episodes.”

  • “…this classification scheme considers a blood glucose <54 mg/dL (3.0 mmol/L) detected by SMBG, CGM (for at least 20 min), or laboratory measurement of plasma glucose as sufficiently low to indicate clinically significant hypoglycemia.”