C, 10.30 In individuals with ASCVD or other CV risk factors on a statin with controlled LDL cholesterol but elevated triglycerides (135499 mg/dL), the addition of icosapent ethyl can be considered to reduce CV risk. More stringent A1C targets (such as <6.5% [48 mmol/mol]) may be appropriate for selected individuals if they can be achieved without significant hypoglycemia or other adverse effects of treatment. A, 15.21 In pregnant individuals with diabetes and chronic hypertension, a BP threshold of 140/90 mmHg for initiation or titration of therapy is associated with better pregnancy outcomes than reserving treatment for severe hypertension, with no increase in risk of small-for-gestational-age birth weight. The 2023 Update to the American Diabetes Association's Standards of Care in Diabetes Endocrinology Advisor Contributing Writer | January 27, 2023 This year's updates to the American Diabetes Association's Standards of Care in Diabetes contain updates to 7 sections, including guidance on vaccinations, comorbidity risk management, and more. A Other oral and noninsulin injectable glucose-lowering medications lack long-term safety data. Multiple means at least three, but many patients may have five or more. Caregivers, school personnel, or family members providing support to these individuals should know where it is and when and how to administer it. A, 5.35 After identification of tobacco or e-cigarette use, include smoking cessation counseling and other forms of treatment as a routine component of diabetes care. A, 5.5 Digital coaching and digital self-management interventions can be effective methods to deliver DSMES. IFG, impaired fasting glucose; IGT, impaired glucose tolerance. C, 6.11 Glucose (approximately 1520 g) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate that contains glucose may be used. Temporarily discontinue at the time of or before iodinated contrast imaging procedures in patients with eGFR 3060 mL/min/1.73 m2. C, 10.20 For people with diabetes aged 4075 at higher CV risk, including those with one or more ASCVD risk factors, it is recommended to use high-intensity statin therapy to reduce LDL cholesterol by 50% of baseline and to target an LDL cholesterol goal of <70 mg/dL. Once insulin therapy is started, a target glucose range of 140180 mg/dL (7.810.0 mmol/L) is recommended for most critically ill and noncritically ill patients. E, 9.14 Clinicians should be aware of the potential for overbasalization with insulin therapy. 5.30 Adults with type 1 diabetes C and type 2 diabetes B should engage in 23 sessions/week of resistance exercise on nonconsecutive days. B, 13.18 Simplification of complex treatment plans (especially insulin) is recommended to reduce the risk of hypoglycemia and polypharmacy and decrease the burden of the disease if it can be achieved within the individualized A1C target. A, 1.3 Care systems should facilitate in-person and virtual team-based care, including those knowledgeable and experienced in diabetes management as part of the team and utilization of patient registries, decision support tools, and community involvement to meet patient needs. B, 6.7 Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with limited life expectancy or where the harms of treatment are greater than the benefits. 8.1 Use person-centered, nonjudgmental language that fosters collaboration between individuals and HCPs, including person-first language (e.g., person with obesity rather than obese person). Request for cancellations must be submitted in writing to cne@mayo.edu. B, 8.16 Obesity pharmacotherapy is effective as an adjunct to nutrition, physical activity, and behavioral counseling for selected people with type 2 diabetes and BMI 27 kg/m2. C, 7.5 Initiation of CGM, CSII, and/or AID early in the treatment of diabetes can be beneficial depending on a persons/caregivers needs and preferences. A, 8.21 People being considered for metabolic surgery should be evaluated for comorbid psychological conditions and social and situational circumstances that have the potential to interfere with surgery outcomes. The American Diabetes Association invites you to exhibit at the 83rd Scientific Sessions in San Diego! The concern that lipid-lowering agents may adversely affect cognitive function is not currently supported by evidence and should not deter their use. Such programs should, at minimum, provide monthly contact and support, recommend ongoing monitoring of body weight (weekly or more frequently) and other self-monitoring strategies, and encourage regular physical activity (200300 minutes/week). CGM devices that are placed on the person with diabetes in the HCPs office (or with remote instruction) and worn for a discrete period of time (generally 714 days). AClear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered, BSupportive evidence from well-conducted cohort studies, CSupportive evidence from poorly controlled or uncontrolled studies, EExpert consensus or clinical experience. In people with diabetes, higher blood glucose levels prior to and during COVID-19 admission have been associated with poor outcomes, including mortality. It is not recommended that statins be discontinued. 4. 3.1 Monitor for the development of type 2 diabetes in those with prediabetes at least annually; modify based on individual risk/benefit assessment. B, 10.23 In adults with diabetes aged >75 years, it may be reasonable to initiate moderate-intensity statin therapy after discussion of potential benefits and risks. Clinical signals that may prompt evaluation of overbasalization include basal dose more than 0.5 units/kg/day, high bedtimemorning or post- to preprandial glucose differential, hypoglycemia (aware or unaware), and high glycemic variability. This year's meeting will be held June 7-11, 2019, at the Moscone Center in San Francisco, California. Diabetes Management Curriculum Design for Inpatient Nurses: Where to Start and Where to Stop? 9.4a Healthy lifestyle behaviors, DSMES, avoidance of clinical inertia, and SDOH should be considered in the glucose-lowering management of type 2 diabetes. A isCGM devices should be scanned frequently, at a minimum once every 8 hours. ACEi, ACE inhibitor; ACR, albumin-to-creatinine ratio; CVOT, cardiovascular outcomes trial; DPP-4i, dipeptidyl peptidase 4 inhibitor; GLP-1 RA, glucagon-like peptide 1 receptor agonist; HHF, hospitalization for heart failure; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T2D, type 2 diabetes. Diabetes Advocacy in the complete 2023 Standards of Care. We look forward to welcoming you to San Diego! E, 9.9 Among individuals with type 2 diabetes who have established ASCVD or indicators of high CV risk, established kidney disease, or HF, a sodiumglucose cotransporter 2 (SGLT2) inhibitor and/or glucagon-like peptide 1 (GLP-1) receptor agonist with demonstrated CVD benefit (Figure 9.3, Table 9.2, and Tables 10.3B and 10.3C in the complete 2023 Standards of Care) is recommended as part of the glucose-lowering regimen and comprehensive CV risk reduction, independent of A1C and in consideration of person-specific factors. If DR is progressing or sight-threatening, then examinations will be required more frequently. 2023 Live (in-person) Diabetes Management 2023 Diabetes Management CNE Nursing Conference. A, 9.6 Early combination therapy can be considered in some individuals at treatment initiation to extend the time to treatment failure. E, 6.13 Hypoglycemia unawareness or one or more episodes of level 3 hypoglycemia should trigger hypoglycemia avoidance education and reevaluation and adjustment of the treatment plan to decrease hypoglycemia. Mayo Clinic College of Medicine and Science designates this activity for a maximum of 13.75 ANCC contact hours. confidence and pride that radiates from the landmark features of San Diego and from the faces of Read More E, 16.10 Treatment regimens should be reviewed and changed as necessary to prevent further hypoglycemia when a blood glucose value of <70 mg/dL (3.9 mmol/L) is documented. If tests are normal, repeat testing at a minimum of 3-year intervals (or more frequently if BMI is increasing or risk factor profile deteriorating) is recommended. When caring for hospitalized people with diabetes, consult with a specialized diabetes or glucose management team when possible. E, 10.28 For individuals with fasting triglyceride levels 500 mg/dL, evaluate for secondary causes of hypertriglyceridemia and consider medical therapy to reduce the risk of pancreatitis. A, 10.47 In people with type 2 diabetes with stable HF, metformin may be continued for glucose lowering if eGFR remains >30 mL/min/1.73 m2 but should be avoided in unstable or hospitalized individuals with HF. The American Diabetes Association (ADA) is taking the best of two worlds from the Advanced Postgraduate Course and the Clinical Conference to bring to you a fresh, new learning experience, outstanding speakers, and leading-edge educational content. 12.4 People with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist at the time of the diabetes diagnosis. and a trip to San Diego offer visitors the chance to see what an American city can accomplish Retinopathy, Neuropathy, and Foot Care, cdc.gov/diabetes/prevention/find-a-program.html, https://professional.diabetes.org/meetings/mental-health-toolkit, https://diabetesjournals.org/journals/pages/license. B, 15.28 Individuals with a history of GDM should have lifelong screening for the development of type 2 diabetes or prediabetes every 13 years. C, 7.7 People who are on insulin using BGM should be encouraged to check their blood glucose levels when appropriate based on their insulin therapy. A, 8.19 Metabolic surgery may be considered as an option to treat type 2 diabetes in adults with BMI 30.034.9 kg/m2 (27.532.4 kg/m2 in Asian American individuals) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. If you are thinking of attending this event, we are here to help you out. confirmation of your hotel reservation. People with diabetes are nearly twice as likely as those without diabetes to be readmitted after hospitalization. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. B, 12.26 A multidisciplinary approach is recommended for individuals with foot ulcers and high-risk feet (e.g., those on dialysis, those with Charcot foot, those with a history of prior ulcers or amputation, those with PAD). C, 5.32 Flexibility training and balance training are recommended 23 times/week for older adults with diabetes. B, 12.29 The use of specialized therapeutic footwear is recommended for people with diabetes at high risk for ulceration, including those with loss of protective sensation, foot deformities, ulcers, callous formation, poor peripheral circulation, or history of amputation. Detail Ada 2023 Conference. C, 10.16 In adults not taking statins or other lipid-lowering therapy, it is reasonable to obtain a lipid profile at the time of diabetes diagnosis, at an initial medical evaluation, and every 5 years thereafter if under the age of 40 years, or more frequently if indicated. The American Diabetes Association is the nation's leading 501(C)3 nonprofit charity providing diabetes research, information and advocacy. The choice of device should be made based on the individuals circumstances, preferences, and needs. Medications approved by the FDA for the treatment of obesity are summarized in Table 8.2 of the complete 2023 Standards of Care. The 2023 guidelines for diabetes care have now been published by the American Diabetes Association (ADA). B. Collaborative, multidisciplinary teams are best suited to provide care for people with diabetes and to facilitate patients self-management with emphasis on avoiding therapeutic inertia to achieve recommended metabolic targets. A, 15.3 Preconception counseling should address the importance of achieving glucose levels as close to normal as is safely possible, ideally A1C <6.5% (48 mmol/mol), to reduce the risk of congenital anomalies, preeclampsia, macrosomia, preterm birth, and other complications. B, 13.3 Screening for early detection of mild cognitive impairment or dementia should be performed for adults 65 years of age or older at the initial visit, annually, and as appropriate. A plan for preventing and treating hypoglycemia should be established for each individual. B, 8.7 Such interventions should include a high frequency of counseling (16 sessions in 6 months) and focus on nutrition changes, physical activity, and behavioral strategies to achieve a 500750 kcal/day energy deficit. Telehealth may increase access to care for people with diabetes. The diagnostic criteria for diabetes and prediabetes are shown in Table 2.2/2.5. through hard work and determination. A Individuals with BP 180/110 mmHg and CVD could be diagnosed with hypertension at a single visit. B, 3.8 Prediabetes is associated with heightened cardiovascular (CV) risk; therefore, screening for and treatment of modifiable risk factors for cardiovascular disease (CVD) are suggested. Refer to a qualified mental health professional or other trained HCP for further assessment and treatment if indicated. ARLINGTON, Va., Dec. 12, 2022 /PRNewswire/ -- Today, the American Diabetes Association (ADA) published Standards of Care in Diabetes2023 (Standards of Care), comprehensive, evidence-based . E, 6.4 TIR is associated with the risk of microvascular complications and can be used for assessment of glycemic control. An insulin schedule with basal and correction components is necessary for all hospitalized individuals with type 1 diabetes, even when taking nothing by mouth, with the addition of prandial insulin when eating. After the onset of puberty or after 10 years of age, whichever occurs earlier. E. Among hospitalized individuals, hyperglycemia, hypoglycemia, and glucose variability are associated with adverse outcomes, including death. The American College of Cardiology/American Heart Association ASCVD risk calculator (Risk Estimator Plus) is generally a useful tool to estimate 10-year risk of a first ASCVD event (available online at tools.acc.org/ASCVD-Risk-Estimator-Plus). Testing should be considered in adults with overweight or obesity (BMI 25 kg/m, High-risk race/ethnicity (e.g., African American, Latino, Native American, Asian American, Pacific Islander), Hypertension (130/80 mmHg or on therapy for hypertension), HDL cholesterol level <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L), Individuals with polycystic ovary syndrome, Other clinical conditions associated with insulin resistance (e.g., severe obesity, acanthosis nigricans). Shorter durations (minimum 75 minutes/week) of vigorous-intensity or interval training may be sufficient for younger and more physically fit individuals. A, 4.5 Ongoing management should be guided by the assessment of overall health status, diabetes complications, CV risk, hypoglycemia risk, and shared decision-making to set therapeutic goals. Visit ADAHighlights.com to participate today! Mark your calendars now for the world's largest, most prominent meeting on diabetes? This continuing education activity is provided by a CBDCE Recognized Continuing Education Provider. 1.5 Assess food insecurity, housing insecurity/homelessness, financial barriers, and social capital/social community support to inform treatment decisions, with referral to appropriate local community resources. Courage. Figure 9.3 and Table 9.2 provide details for informed decision-making on pharmacologic agents for type 2 diabetes. Children and Adolescents in the complete 2023 Standards of Care for specific recommendations regarding the comprehensive treatment of type 1 and type 2 diabetes in children and adolescents. Episodes of hypoglycemia in the hospital should be documented in the medical record and tracked for quality improvement/quality assessment. Lorem Ipsum has been the industry's standard dummy text ever since the 1500s,Lorem Ipsum is simply dummy text of the printing and typesetting industry. A, 11.5d In people with CKD and albuminuria who are at increased risk for CV events or CKD progression, a nonsteroidal MRA shown to be effective in clinical trials is recommended to reduce CKD progression and CV events. Ann Intern Med 2020;173:278286. B, 8.22 People who undergo metabolic surgery should receive long-term medical and behavioral support and routine micronutrient, nutritional, and metabolic status monitoring. Adapted from Davies MJ, Aroda VR, Collins BS, etal. E, 12.20 Gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers are recommended as initial pharmacologic treatments for neuropathic pain in diabetes. Luxurious hotels ranging from 2 to 5-star with huge discounts C, 5.40 When indicated, refer to mental health professionals or other trained HCPs for further assessment and treatment for symptoms of diabetes distress, depression, suicidality, anxiety, treatment-related fear of hypoglycemia, disordered eating, and/or cognitive capacities. C. The management of diabetes in children and adolescents cannot simply be derived from care routinely provided to adults with diabetes. Similarly, the intensity of lipid management can be relaxed, and withdrawal of lipid-lowering therapy may be appropriate. Key points included in standard AGP report. Impact of a Pharmacist-Led Diabetes Care Service for Hispanic Patients at a Free Medical Clinic, Personalized Virtual Care Using Continuous Glucose Monitoring in Adults With Type 2 Diabetes Treated With Less Intensive Therapies, Severe Hypoglycemia and the Use of Glucagon Rescue Agents: An Observational Survey in Adults With Type 1 Diabetes, Human Insulin as an Antidote to the High Cost of Insulin: Clinical Insignificance of Pharmacokinetic/Pharmacodynamic Differences, 1. Such care should be integrated with routine medical care and delivered by trained HCPs using a collaborative, person-centered, culturally informed approach. If any level of DR is present, subsequent dilated retinal examinations should be repeated at least annually by an ophthalmologist or optometrist. Clin Diabetes 2 January 2023; 41 (1): 431. If you are travelling with group or if you are looking to make hotel bookings for a group, our A Refer to neurologist or pain specialist when pain control is not achieved within the scope of practice of the treating physician. B, 13.17 Deintensification of treatment goals is recommended to reduce the risk of hypoglycemia if it can be achieved within the individualized A1C target. Strategies to reduce readmissions include targeting ketosis-prone type 1 diabetes, treating individuals with admission A1C >9% (75 mmol/mol) with insulin, and implementing a transitional care model. A student rate is available. The awards honor academics, health care . A lower A1C goal may be set for an individual if achievable without recurrent or severe hypoglycemia or undue treatment burden. the city's inhabitants as well. 6.10 Occurrence and risk for hypoglycemia should be reviewed at every encounter and investigated as indicated. 1998-2023 Mayo Foundation for Medical Education and Research. The importance of routine vaccinations for people with diabetes has been elevated by the coronavirus disease 2019 (COVID-19) pandemic. Hypertension, defined as a systolic BP 130 mmHg or a diastolic BP 80 mmHg, is common among people with either type 1 or type 2 diabetes. E, 7.2 When prescribing a device, ensure that people with diabetes/caregivers receive initial and ongoing education and training, either in-person or remotely, and ongoing evaluation of technique, results, and their ability to utilize data, including uploading/sharing data (if applicable), to monitor and adjust therapy. A, 11.4d Do not discontinue renin-angiotensin system blockade for increases in serum creatinine (30%) in the absence of volume depletion. 16.9 A hypoglycemia management protocol should be adopted and implemented by each hospital or hospital system. A block of rooms has been reserved for conference attendees and their guests at Disney's Coronado Springs Resort at a rate of $245/night. All refunds will be made using the same method as the original payment. A, 16.5 More stringent goals, such as 110140 mg/dL (6.17.8 mmol/L) or 100180 mg/dL (5.610.0 mmol/L), may be appropriate for selected patients and are acceptable if they can be achieved without significant hypoglycemia. B. The 35th Annual Clinical Conference on Diabetes will be held virtually on 10-13 June 2021. Postprandial glucose measurements should be made 12 hours after the beginning of the meal, generally peak levels in patients with diabetes. This is an abridged version of the current Standards of Care containing the evidence-based recommendations most pertinent to primary care. You just have to fill out the housing form, check for available options, and choose the hotel available and the one you like from the list, book directly by online secure payments. Once the BGM or glucose pattern is trending up, the individual should consume a meal or snack to prevent recurrence of hypoglycemia. Goals should be individualized based on duration of diabetes, age/life expectancy, comorbid conditions, known CVD or advanced microvascular complications, hypoglycemia unawareness, and individual patient considerations (as per Figure 6.2 in the complete 2023 Standards of Care). 14.63 A reasonable A1C target for most children and adolescents with type 2 diabetes is <7% (53 mmol/mol). E, 10.41 Among people with type 2 diabetes who have established ASCVD or established kidney disease, an SGLT2 inhibitor or GLP-1 receptor agonist with demonstrated CVD benefit (see Tables 10.3B and 10.3C in the complete 2023 Standards of Care) is recommended as part of the comprehensive CV risk reduction and/or glucose-lowering regimens. Diabetes Technologies in the complete 2023 Standards of Care for more information on insulin delivery systems, including insulin syringes, pens, connected pens, pumps, and AID systems; software systems; and digital health systems that combine technology with online or virtual coaching. Promote increase in nonsedentary activities above baseline for sedentary individuals with type 1 diabetes E and type 2 diabetes. Diabetes self-management in the hospital may be appropriate for specific individuals who wish to continue to perform self-care while acutely ill. See 16. A, 9.10 In adults with type 2 diabetes, a GLP-1 receptor agonist is preferred to insulin when possible. C, 8.11 For those who achieve weight loss goals, long-term (1 year) weight maintenance programs are recommended when available. (See 10. are available near the San Diego Convention Center, San Diego, USA. 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