Hyperglycemia is more common in those with diabetes and food insecurity, the authors noted in the guidelines. They state that the steady consumption of carbohydrate-rich processed foods, binge eating, and nonadherence to diabetes medications owing to financial constraint also complicate diabetes management.
Furthermore, studies suggest that anxiety and depression can lead to poor diabetes self-care behaviors. The guidelines state that clinicians need be well-versed in these risk factors for hyperglycemia and take practical steps to alleviate these issues to improve glucose control.
Other updates to the 2016 Standards include expanding the scope for treating different populations with diabetes. New recommendations address diabetes self-management education and support, psychosocial issues, and treatment for youth with type 2 diabetes. An in-depth section on older adults provides a framework for treatment based on cognitive impairment, coexisting chronic illnesses, and functional status.
For women of child-bearing age, there are new recommendations on pre-gestational diabetes, gestational diabetes, and diabetes management during pregnancy.
Racial, Ethnic, and Socioeconomic Concerns
Recent epidemiologic data show that risk for diabetes and its complications differ by racial, ethnic, and socioeconomic status, according to Dr Ratner.
“We point these out in an attempt to rectify them moving forward,” he said.
“For example, Asian Americans are prone to type 2 diabetes at a BMI greater than 23 kg/m2, whereas other groups only begin to see an increase at 25 kg/m2. In addition, African Americans with diabetes are more prone to hypertension and diabetic kidney disease than other ethnic groups and should receive more aggressive screening and intervention,” Dr Ratner told Endocrinology Advisor.
“Ultimately, we are emphasizing the patient-centered approach to diabetes management, meeting the specific needs of the person with diabetes.”
Intensive glucose control is not advised for the improvement of poor cognitive function in hyperglycemic individuals with type 2 diabetes, Dr Ratner noted. The guidelines state in individuals with poor cognitive function or severe hypoglycemia, glycemic therapy should be tailored to avoid significant hypoglycemia.
The guidelines also address patients with HIV. They note that these patients should be screened for diabetes and prediabetes using a fasting glucose level before starting antiretroviral therapy. The recommendations also include re-screening these patients 3 months after starting or changing antiretroviral therapy. If initial screening results are normal in patients with HIV, then checking fasting glucose each year is adequate, according to the guidelines.
Individuals with diabetes and their families and health care providers are constantly challenged to achieve diabetes treatment goals, according to Dr Herman. He said the Standards of Care cohesively outline goals for effective diabetes treatment in one place and as a result make diabetes management more accessible.