Diabetes Care Recommendations Overview 2023

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Questions and Answers

What key aspect was emphasized in Recommendation 1.5 regarding diabetes care?

Reducing the number of healthcare providers involved.

Importance of quality improvement initiatives. (correct)

Increase in medication types.

Focus on dietary changes only.

Which model emphasizes a patient-centered approach in healthcare?

Accountable Care Organizations. (correct)

Fee-for-service model.

Traditional hospital care model.

Standardized care delivery model.

What was added to assist with the interpretation of laboratory measurements for diabetes?

New dietary guidelines.

A list of symptom checklists.

Patient education tools.

Table 2.3 for laboratory measurements. (correct)

What is the purpose of interprofessional teams in diabetes care?

To support sustainable quality improvement. Signup and view all the answers

Which component was endorsed in Section 4 for its relevance in diabetes care?

Bone health. Signup and view all the answers

What is the primary purpose of updating Recommendation 14.41?

To include the Ipswich touch test for neurological assessment Signup and view all the answers

What does Recommendation 12.29 highlight in its revision?

The significance of smoke cessation and counseling referrals Signup and view all the answers

What change was made to Recommendation 14.50 regarding screening intervals?

Screening should now occur at least every 2 years if results are normal Signup and view all the answers

What information was included in the updated Table 15.1?

A folic acid supplement recommendation of 400–800 mg/day Signup and view all the answers

What modification was made to Recommendation 14.60 regarding A1C goals?

To recommend a specific A1C target Signup and view all the answers

What recommendations were added concerning the treatment of individuals with type 2 diabetes?

Using GLP-1 RA and pioglitazone Signup and view all the answers

What was included in the discussion regarding medication accessibility?

Strategies for mitigating financial barriers Signup and view all the answers

Which GLP-1 RA combinations were mentioned for individuals with MASH or MASLD?

Dual GIP with GLP-1 RA Signup and view all the answers

What is emphasized in the revised recommendations regarding glucose-lowering therapy?

Evidence-based selection based on individualized goals Signup and view all the answers

What additional guidance was provided related to ketoacidosis?

Guidance on mitigating risks for at-risk individuals Signup and view all the answers

What was a significant revision made in the pharmacologic approaches section?

Adding new subsections for individualized treatment Signup and view all the answers

Which treatment options were included in the updated recommendations aside from GLP-1 RA?

Pioglitazone and combinations with GLP-1 RA Signup and view all the answers

What recommendation pertains to individuals of childbearing potential?

Specific care considerations Signup and view all the answers

What recent revision specifies when to screen for the risk of gestational diabetes mellitus?

Recommendation 4.22a Signup and view all the answers

Which recommendation was updated to avoid medications associated with higher fracture risk?

Recommendation 4.12 Signup and view all the answers

What is the purpose of the revised Recommendation 4.24?

To refer individuals at higher risk for significant liver fibrosis Signup and view all the answers

What addition to the guidelines highlights the relationship between sleep health and diabetes risk?

Lifestyle Behavior Change for Type 2 Diabetes Prevention Signup and view all the answers

Which recommendation discusses antiresorptive medications and osteoanabolic agents?

Recommendation 4.13 Signup and view all the answers

What does Recommendation 4.13 emphasize for adults with type 2 diabetes or prediabetes?

To perform additional risk stratification with FIB-4 >1.3 Signup and view all the answers

Which new recommendation was added regarding dental care for people with diabetes?

Referral for dental exams at least once per year Signup and view all the answers

What aspect of diabetes treatment does Recommendation 4.16 address?

Physical activity and weight loss programs Signup and view all the answers

What was added to the recommendations concerning sexual health in women?

Inquiries about sexual health Signup and view all the answers

What does Recommendation 4.28 focus on?

Initiation of thyroid hormone receptor-b agonist therapy Signup and view all the answers

What is the primary goal mentioned in Recommendation 4.3?

Assess glycemic status in patients Signup and view all the answers

Which recommendation was revised to include actionable language regarding dietary supplements?

Recommendation 5.16 Signup and view all the answers

Which key aspect was illustrated in the newly added Fig. 5.1?

Religious versus intermittent fasting Signup and view all the answers

What does Table 5.4 provide for people with diabetes who wish to fast during Ramadan?

Risk calculation and suggested risk score Signup and view all the answers

What type of specialist should be referred for management of MASLD according to the recommendations?

Hepatologist Signup and view all the answers

What is the recommended weight loss target for adults with overweight or obesity and MASLD?

3–7% Signup and view all the answers

Which of the following is a recommended treatment goal for individuals with type 2 diabetes?

Reducing hypoglycemia risk Signup and view all the answers

What is preferred over insulin for adults with type 2 diabetes in the absence of evidence of insulin deficiency?

GLP-1 RA or a dual GIP and GLP-1 RA Signup and view all the answers

What condition does Recommendation 10.26 address regarding lipid-lowering agents?

They should be avoided in sexually active individuals of childbearing potential. Signup and view all the answers

What was revised in Recommendation 9.27 regarding basal insulin?

To remove consideration of doses exceeding 0.5 units/kg/day as evidence of overbasalization Signup and view all the answers

What aspect does the revised Figure 9.4 focus on?

Clarity in the list of options for prandial insulin Signup and view all the answers

Which monitoring is specified for individuals taking ACE inhibitors, ARBs, or mineralocorticoid receptor antagonists?

Increased serum creatinine levels Signup and view all the answers

What is one of the risks that treatment recommendations consider?

Cost and access Signup and view all the answers

Which population should exercise caution when prescribed ACE inhibitors, ARBs, or mineralocorticoid receptor antagonists?

Individuals who smoke and have a prior history of lower-extremity complications Signup and view all the answers

Study Notes

General Changes

Diabetes care is rapidly evolving with new research, technology, and treatments.
The 2025 Standards of Care incorporates person-first and inclusive language.
Efforts were made to consistently apply empowering terminology, recognizing the individual as central to diabetes care.
Changes in evidence levels (e.g., from E to C) are not always noted in the revisions, if the clinical recommendation remains the same.
Substantive revisions are detailed in separate sections.

Section 1: Improving Care and Promoting Health in Populations

Recommendation 1.1 broadened to include individuals at risk for diabetes, in addition to those with the condition.
Recommendation 1.2 expanded to include various care delivery models, such as the Patient-Centered Medical Home and Accountable Care Organizations, in addition to the Chronic Care Model.
Recommendation 1.5 emphasizes improved quality of care through quality improvement initiatives and interprofessional teams.
Recommendation 1.6 highlights the importance of addressing disparities in diabetes care.
Recommendation 1.7 stresses screening and addressing social determinants impacting diabetes management.

Section 2: Diagnosis and Classification of Diabetes

Table 2.3 provides considerations for interpreting glucose and A1C measurements.

Section 3: Prevention or Delay of Diabetes and Associated Comorbidities

The "Lifestyle Behavior Change for Type 2 Diabetes Prevention" section now includes sleep health in relation to type 2 diabetes risk.
The "Pharmacologic Interventions to Delay Type 2 Diabetes" section extensively updated the text on potential vitamin D intervention and long-term metformin use.

Section 4: Comprehensive Medical Evaluation and Assessment of Comorbidities

Assessment for glycemic status and prior treatment during initial and follow-up visits is recommended.
Essential components for assessment, planning, and referral are detailed in Table 4.2.
Routine screening for autoimmune thyroid disease is recommended.
Avoiding medications with high fracture risks is recommended.
Intake of calcium for those with diabetes is included in the guidelines.
Timing of antiresorptive and osteoanabolic medications is specified.
A new section, "Dental Care," was added with recommendations for annual dental exams.
Interprofessional teams should be involved in MASLD and MASH management.
Table 4.4 now specifies when bone mineral density testing should be performed.
Inquiring about current sexual health practices is now encouraged, and appropriate screening and referrals are recommended as needed.

Section 5: Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes

All people with diabetes should participate in diabetes self-management education and support (DSMES).
DSMES should be culturally appropriate and responsive to individual preferences.
Screening for behavioral health concerns and DSMES needs are encouraged .
Time spent sedentary should be limited.
Recommendations now emphasize using remote-delivery modalities for DSMES.
Consideration for religious fasting is now included.
Nutritional recommendations now include processed foods, lean proteins, non-dairy alternatives, in addition to dietary supplements for glycemic benefits.
Actionable advice on limiting sodium is provided.
Recommendations on water and nonnutritive sweeteners are now included.
Screening for malnutrition, especially in surgical or pharmacotherapy patients, is recommended.
The importance of identifying and addressing social determinants of health is highlighted.

Section 6: Glycemic Goals and Hypoglycemia

Routine screening for fear of hypoglycemia is encouraged.
A new subsection is added concerning hyperglycemic crisis management (DKA and HHS).
Outpatient preventive education of DKA and HHS is now addressed.

Section 7: Diabetes Technology

Diabetes technology consideration should begin at diagnosis.
Standardized reporting for CGM, connected insulin devices, and AID systems is encouraged.
Mention of potential interference of substances with glucose readings is included.

Section 8: Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes

Additional measurements of body fat distribution may be warranted if BMI is indeterminate.
Monitoring of anthropometric measurements every three months during active weight management is recommended.

Section 9: Pharmacologic Approaches to Glycemic Treatment

Separate recommendations are provided for individuals with diabetes, regardless of their type.
Insulin administration techniques are expanded to include inhaled insulin and insulin bolus patches.
Treatment selection should consider cost, access, risk for adverse reactions, individual preferences, and more.
Considerations of glucose-lowering medications' effects on MASLD and MASH were added (Table 9.3 and Fig. 9.3).
Reassessing the need for hypoglycemia-risking medications when starting new glucose-lowering medications is recommended.

Section 10: Cardiovascular Disease and Risk Management

Appropriate monitoring of blood pressure is detailed.
Medications for confirmed hypertension in non-pregnant patients with diabetes are specified.
Monitoring of serum creatinine, potassium, and hypokalemia is addressed when administering specific medications.
Clarified information on managing hypertensive medication in pregnancy is provided.

Section 11: Chronic Kidney Disease and Risk Management

Clarity about blood pressure management goals for those with chronic kidney disease (CKD) is included.
Titration of ACE inhibitors or ARBs to the maximum tolerated dose is emphasized to slow progression of CKD and to reduce cardiovascular events in non-pregnant patients with diabetes and hypertension.
Monitoring of serum creatinine, potassium, and hypokalemia is addressed when administering specific medications for CKD.

Section 12: Retinopathy, Neuropathy, and Foot Care

Regular ophthalmologist visits are recommended if retinopathy is progressing or sight-threatening.
Importance of dilated eye exams, especially prior to and during first-trimester pregnancy, is highlighted.
Recommendations concerning opioid use for neuropathic pain were modified.
Increased emphasis was placed on smoke cessation and counseling for those with a history of lower-extremity complications.

Section 13: Older Adults

The 4Ms framework (Mentation, Medications, Mobility, and What Matters Most) is introduced in diabetes management.
Time in range, time below range, and A1C treatment goals are to be considered.

Section 14: Children and Adolescents

An A1C goal of <6.5% (<48 mmol/mol) for most children and adolescents with type 2 diabetes is recommended.
The term "hyperglycemic hyperosmolar nonketotic syndrome" has been superseded by "hyperglycemic hyperosmolar state."
Explicitly avoid substance use (vaping and e-cigarettes).
Pediatric diabetes specialists should engage in shared decision-making with families.

Section 15: Management of Diabetes in Pregnancy

Management of diabetes during pregnancy is now consolidated for clarity.
Consolidation of glucose goals for preexisting diabetes and gestational diabetes is featured.
Recommendations on insulin delivery modalities during labor, delivery, and postpartum are now included.
Addressing new guidelines relating to preeclampsia, aspirin, and blood pressure in pregnancy.

Section 16: Diabetes Care in the Hospital

The initiation/intensification of insulin is emphasized for both critically and non-critically ill individuals.
Glycemic goals of 140-180 mg/dL (7.8-10.0 mmol/L) are emphasized.
Emphasis on continuation of insulin pumps or AID systems, when clinically appropriate, during hospitalization.

Section 17: Diabetes Advocacy

This section now covers diabetes care in schools, driving, and detention facilities.

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Description

Test your knowledge on the latest diabetes care recommendations and guidelines. This quiz covers key aspects such as patient-centered approaches, interprofessional teams, and updates on laboratory measurements. Dive into the details of recommendations aimed at improving diabetes management.