A summary of updates is shown in the Table, with more information on select recommendations described below.
Cardiovascular Disease Risk Management
All people with diabetes should be treated with statin therapy in addition to lifestyle therapy, according to the updated guidelines. Moderate-dose statin therapy is recommend for people with diabetes age <40 years and for those age 40 to 75 years with no additional cardiovascular disease risk factors. High-dose statin therapy is recommended for people with diabetes of all ages who have cardiovascular disease, and for those age 40 to 75 years who have additional cardiovascular risk factors. In all patients, the dose of statin therapy should be individualized based on treatment response. The changes are in alignment with guidelines for cardiovascular risk management from the American College of Cardiology and American Heart Association.
The ADA recommends that a screening lipid profile is “reasonable” at the time of diabetes diagnosis, at an initial medical evaluation, and/or at age 40 years, and periodically thereafter (eg, every 1 to 2 years).
In addition, the ADA raised the recommended target for diastolic blood pressure to <90 mm Hg (from <80 mmHg), adding that lower diastolic targets may be appropriate in select individuals, such as younger people.
Lower BMI Cut Point for Screening in Asian Americans
The ADA lowered the body mass index (BMI) cut point for diabetes screening from ≥25 kg/m2 to ≥23 kg/m2 in Asian Americans. This change was made in light of evidence that many Asian Americans develop diabetes at lower BMI levels than the general U.S. population.
“The position statement highlights, for the first time, the physiologic differences seen between Asian Americans and other populations affected by diabetes,” ADA Senior Vice President for Medical Affairs and Community Information Jane Chiang, MD, said in a statement to the press.
The updated guidelines recommend a pre-meal blood glucose target of 80 to 130 mg/dL (compared to 70 to 130 mg/dL previously). In addition, for children and adolescents, the ADA recommends a target hemoglobin A1c of <7.5% in children and adolescents, with individualization being encouraged.
February 25, 2015
American Diabetes Association. 2. Classification and Diagnosis of Diabetes. Diabetes Care. 2015;38:S8-S16.
American Diabetes Association. 4. Foundations of Care: Education, Nutrition, Physical Activity, Smoking Cessation, Psychosocial Care, and Immunization. Diabetes Care. 2015;38(Supplement 1):S20-S30.
American Diabetes Association. 8. Cardiovascular Disease and Risk Management. Diabetes Care. 2015;38(Supplement 1):S49-S57.
American Diabetes Association. 11. Children and Adolescents. Diabetes Care. 2015;38(Supplement 1):S70-S76.
Hsu WC, Araneta MR, Kanaya AM, Chiang JL, Fujimoto W. BMI Cut Points to Identify At-Risk Asian Americans for Type 2 Diabetes Screening. Diabetes Care. 2015;38(1):150-158.