Recently the American Diabetes Association have updated the “Standards of Medical Care in Diabetes” for 2018 which was published in the journal of Diabetes Care. The important updates include new treatment recommendations for adults with type 2 diabetes mellitus (T2DM) including an updated algorithm for antihyperglycemic agents based on the data from recent cardiovascular outcome studies and a new algorithm suggesting the recommended antihypertensive therapies for T2DM patients with confirmed hypertension.

Metformin, if not contraindicated and if tolerated, is the preferred initial pharmacologic agent for the treatment of type 2 diabetes. The updated algorithm for antihyperglycemic agents emphasises the use of agents having positive results from their respective cardiovascular outcome trails (CVOTs) namely canagliflozin, empagliflozin and liraglutide among patients with established Atherosclerotic Cardiovascular Disease (ASCVD) after considering drug-specific and patient factors. There is also a new table which summarises the drug-specific and patient factors of antihyperglycemic agents. In this table canagliflozin and empagliflozin are the two sodium glucose cotransporter-2 inhibitors (SGLT2i) suggested to be beneficial for T2DM patients with ASCVD, congestive heart failure (CHF) and diabetic kidney disease (DKD).

Apart from this, the guidelines also highlight the evidence from Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD BP) trial; the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation—Blood Pressure (ADVANCEBP) trial; the Hypertension Optimal Treatment (HOT) trial; and the Systolic Blood Pressure Intervention Trial (SPRINT) which support ADAs recommendations that most adults with diabetes and hypertension should have a target blood pressure of <140/90 mmHg and that risk-based individualization to lower targets, such as 130/80 mmHg, may be appropriate for some patients.

Also, this year the ADA has underlined that all hypertensive patients with diabetes monitor their blood pressure at home to help identify potential discrepancies between office vs. home blood pressure, and to improve medication-taking behavior and testing for prediabetes and type 2 diabetes should be considered in children and adolescents younger than 18 years of age who are overweight or obese and have one or more additional risk factors for diabetes.

The ADA also emphasizes the limitations of HbA1c and suggest that healthcare providers should use the correct type of HbA1c test and to consider alternate diagnostic tests (fasting plasma glucose test or oral glucose tolerance test) if there is disagreement between HbA1c and blood glucose levels.

Reference:

American Diabetes Association (ADA) Standards of Medical Care in Diabetes-2018. Diabetes Care Volume 41, Supplement 1, January 2018.