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Updated Guidelines for Diabetes Released by the American Diabetes Association

Knowledge about guideline updates are important for people with diabetes too

New recommendations concerning cholesterol lowering drugs for all patients with diabetes, a lower BMI cut point for screening Asian Americans for diabetes, and new blood sugar targets for children and adolescents are among the many the updates in the American Diabetes Association’s (ADA’s) annual revised Standards of Medical Care, which was published in the January issue of Diabetes Care.

Managing the Risk for Heart Disease
The ADA now recommends that all people with type 2 diabetes take the cholesterol lowering drugs—statins in addition to lifestyle therapy (meal planning changes and exercise) to reduce the likelihood of developing heart disease (eg, heart attack and stroke).

  • The dose of statin therapy should be based on a person’s risk for cardiovascular disease.

In addition, the ADA recommended a less strict goal for diastolic blood pressure—80 mmHg compared with 90 mmHg in the past. Diastolic blood pressure is the bottom number in a blood pressure measurement, and measures the pressure in your arteries in between heartbeats when your heart is at rest.

Lower Diabetes Screening Cutoff for Asian Americans
Many Asian Americans develop diabetes at a lower body weight because they tend to gain weight around their waist, which is linked to a greater risk for diabetes and cardiovascular disease compared with weight gain in thighs and other parts of the body.

Because of this difference in weight gain, the ADA has lowered the recommended body mass index (BMI) for screening Asian Americans for diabetes from ≥25 kg/m2 (the cutoff for the general public) to ≥23 kg/m2. Body mass index is a measure of body fat based on a person’s weight and height.

Blood Sugar Goals for Children and Adolescents
All children and adolescents with diabetes should aim to reach a target blood sugar level (hemoglobin A1c) of <7.5%, keeping in mind that this target may need to be changed based on how a child responds to treatment.

Pneumonia Vaccine Recommended for All Seniors
All adults age ≥65 years (with or without diabetes) should receive the pneumococcal conjugate vaccine 13 (PCV13) followed by PPSV23 6 to 12 months later if they have never received these vaccines before. This recommendation also was made by the Centers for Disease Control and Prevention in 2014.

Foot Examinations May Be Needed at Every Visit
A foot examination is recommended at every office visit for people with diabetes who have lost sensitivity or feeling in their feet or who have foot deformities or a history of foot ulcers.

Exercise Recommendations
Other changes to the ADA guidelines include a new recommendation that all people with or without diabetes break up periods of inactivity (such as sitting at the computer or TV) throughout the day so that they spend no more than 90 minutes at a time sitting. The ADA also recommends resistance training at least twice a week, unless otherwise instructed by their doctors for medical reasons, in addition to exercising at a moderate level for at least 150 minutes each week spread over at least 3 days.

Resistance training, also known as strength training or weight training, is exercise that builds muscle. Examples of resistance training include lifting weights, using resistance bands, or lifting your body weight (eg, push-ups, crunches, lunges, pull-ups, etc).

Talk to your healthcare provider before making any changes to your diabetes treatment plan.

February 25, 2015

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