The American Diabetes Association (ADA) has issued three important updates to its 2019 Standards of Medical Care in Diabetes based on recently published literature. These updates principally focus on people with cardiovascular disease and diabetes, and for those with chronic kidney disease (CKD) and diabetes.

The latest updates published March 27, 2019 are as follows:

• Section 10 on “Cardiovascular disease and risk management” was updated based on the outcome of Reduction of Cardiovascular Events with Icosapent Ethyl–Intervention Trial (REDUCE-IT), which determined the addition of icosapent ethyl to statin therapy for patients with high triglyceride.

The ADA Standards of Care now also recommends that icosapent ethyl be considered for patients with diabetes and atherosclerotic cardiovascular disease (ASCVD) or other cardiac risk factors on a statin with controlled LDL-C, but with elevated triglycerides to reduce cardiovascular risk.

• Sections 9 (Pharmacologic approaches to glycemia treatment), 10 and 11 (Microvascular complications and foot care) include several revisions based on findings from the Dapagliflozin Effect on Cardiovascular Events - Thrombosis in Myocardial Infarction 58 (DECLARE-TIMI 58) trial, in which dapagliflozin (a sodium-glucose cotransporter type 2 [SGLT2] inhibitor) reduced hospitalization for heart failure and progression in CKD.
• The approved use per estimated glomerular filtration rate (eGFR) has been revised from ≥60 mL/min/1.73 m2 to ≥45 mL/min/1.73 m2 for patients with diabetes and CKD in Section 11 of the Standards of Care.

(Source: ADA press release, March 27, 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA