Revised ADA Standards Allow Personalized Approach to Diabetes Treatment

New glycemic targets, changes in blood pressure (BP) goals and revised recommendations on statin therapy are among the updates included in the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes for 2015.

The new guidelines are part of the ADA’s annually revised Standards of Medical Care in Diabetes, which was recently published in a special supplement to the January 2015 issue of Diabetes Care.¹

Of note, this year, the new Standards have been reorganized and renamed. In previous years, the ADA issued clinical practice recommendations with a section on the Standards of Medical Care in Diabetes. The association now issues a single Standards of Medical Care document that is divided into 14 sections.

The Standards are based on the most up-to-date research and are reviewed by a multidisciplinary Professional Practice Committee.

New Glycemic Targets

In keeping with the 2014 Standards, target HbA1c is approximately 7% or less for all nonpregnant adults with diabetes. The ADA has, however, has changed its recommendation on premeal blood glucose targets. The guidelines now suggest a premeal blood glucose target of 80 mg/dL to 130 mg/dL rather than 70 mg/dL to 130 mg/dL.

Also, in an update from last year’s guidelines, the ADA now recommends an HbA1c target of less than 7.5% for children and adolescents with diabetes.

The ADA is lowering its target recommendation for blood glucose levels for children with type 1 diabetes to reflect new scientific data and to harmonize its guidelines with those of the International Society for Pediatric and Adolescent Diabetes.

The guidelines recommend that children under age 19 years with type 1 diabetes strive to maintain an HbA1c level lower than 7.5%. Until now, target levels could be as high as 8.5% for children aged younger than 6 years, 8.0% for children aged 6 to 12 years and 7.5% for adolescents. The previous guidelines were in place because of concerns over complications caused by hypoglycemia. 

“We have recently refined our targets in children to reflect a worldwide consensus. We no longer break it down by age. We have dropped the targets to 7.5%,” said Robert Ratner, MD, who is Chief Scientific and Medical Officer for the American Diabetes Association.

Consistent with the 2014 recommendations, the guidelines still note that providers can suggest more stringent HbA1c goals, such as less than 6.5%, for select adult patients, if this can be achieved without significant hypoglycemia or other adverse treatment effects, and less stringent HbA1c goals for those with a history of severe hypoglycemia, limited life expectancy, advanced vascular complications and extensive comorbidities.

“A personalized approach is what we have moved to in both type 1 and type 2 diabetes,” Dr. Ratner said in an interview with Endocrinology Advisor. “In adults, it is totally due to comorbidities and the life expectancy. We have to individualize the goals of therapy to maximize the functional capacity of the person with diabetes. In those who are young, we are much more aggressive and active and want the HbA1c to be less than 7%, but in others 7% and 8% are probably quite appropriate.”