The American Diabetes Association (ADA) has released the 2017 update to their Standards of Medical Care in Diabetes (Standards).1 The document is reviewed each year by a multidisciplinary committee of experts in diabetes care, which examines relevant research that informs the revisions.
“The most recent update to the ADA Standards of Medical Care addresses many new and important issues regarding the management of patients with diabetes,” Kevin M. Pantalone, DO, staff endocrinologist and director of clinical research at the Cleveland Clinic Foundation in Ohio, told Endocrinology Advisor. The 2017 Standards contain the usual guidelines pertaining to type 2 diabetes prevention and the diagnosis and treatment of type 1, type 2, and gestational diabetes. Additionally, Dr Pantalone identified several of the most notable updates.
One recommendation suggests considering metabolic surgery for patients with obesity and uncontrolled type 2 diabetes who have a body mass index (BMI) as low as 30 kg/m2 (27.5 kg/m2 for Asian Americans). This update is based on a growing body of research showing that metabolic surgery — previously referred to as bariatric surgery — leads to improved glycemic control and reduced cardiovascular disease (CVD) risk in this patient population compared with other medical and lifestyle interventions.2 The Committee also noted that the safety of metabolic surgery has significantly improved in the past 2 decades: Related mortality rates are 0.1% to 0.5%, which are similar to the rates associated with hysterectomy or cholecystectomy.2
Another update recommends considering 2 specific glucose-lowering therapies (glucagon-like peptide-1 [GLP-1] receptor agonists or sodium-glucose cotransporter-2 [SGLT2] inhibitors) for high-risk patients with CVD who have type 2 diabetes, which is in line with the findings of recently published clinical trials, including the EMPA-REG OUTCOME (ClinicalTrials.gov identifier: NCT01131676) and LEADER (ClinicalTrials.gov identifier: NCT01179048) trials.
The EMPA-REG OUTCOME study examined the effects of the SGLT2 inhibitor empagliflozin vs placebo and usual care in high-risk patients with CVD who have diabetes.3 The findings show that the drug led to a 14% reduction in the composite outcome of myocardial infarction (MI) and stroke, and a 38% reduction in CV death over a median follow-up period of 3.1 years.3 As a result, the US Food and Drug Administration (FDA) added a new indication for empagliflozin to reduce CV mortality risk in adults with type 2 diabetes and heart disease.4 In a similar manner, results from the LEADER trial showed that the GLP-1 receptor agonist liraglutide resulted in fewer MI, stroke, or CV deaths compared with placebo (13% vs 14.9%) over a median follow-up period of 3.8 years.5