The ADA updates their guidelines and care standards for patients with diabetes annually. The full recommendations are available online. The key evidence-based consensus recommendations are as below:
- Patients with intensive insulin regimens (multiple insulin injections daily or continuous insulin infusions) require frequent blood glucose self-monitoring. Self-monitoring of blood glucose should occur no fewer than 6 to 10 times daily. (B)
- Continuous glucose monitoring can lower glycosylated hemoglobin (HbA1c) in selected adults. (C)
- HbA1c level should be monitored twice annually in patients who achieve treatment and glycemic goals and more frequently in those who do not meet glycemic goals. Avoiding hypoglycemia takes precedence over achieving HbA1c targets. (E)
- Glycemic goals
- HbA1c goals for nonpregnant adults is <7%, but this target can be liberalized to <8% for patients with histories of severe hypoglycemia or comorbid diseases. (A)
- HbA1c goal can be more strict (<6.5%) in patients with short duration of diabetes, long life expectancy, and no clinically significant cardiovascular disease. (C)
- Pharmacologic therapy
- Insulin therapies require patient education to match dosing to carbohydrate intake, premeal glucose levels, and anticipated physical activity.
- Intensive glycemic monitoring should be encouraged in active patients with family participation.
- Rapid-acting inhaled insulin is noninferior to aspart insulin for HbA1c lowering and is less likely to cause hypoglycemia.
- Although most hypoglycemia is managed with oral glucose or other carbohydrates, patients who are at risk for significant hypoglycemia can be prescribed glucagon for administration by family members, caregivers, or school personnel. (E)
- Patients with clinically significant hypoglycemia, or severe hypoglycemia with unawareness, should raise their glycemic targets transiently for several weeks both to avoid hypoglycemia and to improve hypoglycemia awareness. (A)
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Dr. Kamal Kant Kohli
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