New Standards of Care in Diabetes
Diabetes affects over 29 million Americans. This condition hinders the body’s ability to properly process food. Most of the food we eat is turned into glucose to be used for energy. The pancreas makes a hormone called insulin to help the body’s cells absorb glucose. When you have diabetes, the body either doesn’t make enough insulin or the cells can’t effectively use the insulin that is made. When there is insufficient insulin, blood glucose levels become high. This leads to diabetes complications.
Proper management of diabetes is necessary to prevent complications. The Standards of Medical Care in Diabetes provides evidence-based clinical practice recommendations for diabetes care. Updated in January of 2015, below is a summary of the minor changes that clarify recommendations or reflect new evidence:
- The American Diabetes Association now recommends a pre-meal blood glucose target of 80-130 mg/dL (rather than 70-130 mg/dL) to better reﬂect new data comparing actual average glucose levels with A1C targets.
- A new blood sugar standard for children and adolescents ― a hemoglobin A1C of <7.5 or less.
- Physical activity. All individuals, including those with diabetes should limit the time they spend in sedentary activities by breaking up extended amounts of time spent sitting.
- Body Mass Index (BMI) and the Asian population. BMI, a measure of the level of body fatness, is used to screen for weight categories that may lead to health problems. For the general population, a BMI of 25 is considered overweight. There was a lowering of BMI threshold to 23 for screening Asian-Americans for diabetes. This population experiences higher risk for diabetes at a lower BMI.
- Diabetics are more likely to have high blood pressure. The recommended goal for diastolic blood pressure was changed from 80 mmHg to 90 mmHg for most people with diabetes and hypertension. Lower diastolic targets may still be appropriate for certain individuals.
- Risk status rather than a person’s LDL cholesterol level will drive the decision to initiate statin (cholesterol lowering medication) treatment or lipid monitoring.
- To better target individuals who are at higher risk for foot problems, new recommendations suggest that individuals with insensate (devoid of sensation or feelings) feet, foot deformities or a history of foot ulcers have their feet examined at every visit.
- People 65 or older should get the pneumonia vaccine in two separate shots ― PCV13 (Prevnar), followed 12 months later by PPSV23 (Pneumovax).
The new Standards also state that e-cigarettes are NOT an alternative to smoking or a way to help smokers quit.
Reference: Standards of Medical Care in Diabetesd2015: Summary of Revisions. Diabetes Care 2015;38 (Suppl. 1):S4
Written by Ingrid Adams, Nutrition and Weight Management Specialist; University of Kentucky, College of Agriculture, Food and Environment. Edited by Lauren State, Oldham County Extension Staff Assistant. Reviewed by Chris Duncan, Oldham County Family & Consumer Sciences Agent.