ada diabetes guidelines 2020

SGLT2 inhibitors and GLP-1 receptor agonists should be considered for patients with type 2 diabetes and CKD who require another drug added to metformin to attain target A1C or cannot use or tolerate metformin.

C, 2.9 For all people, testing should begin at age 45 years. Providers caring for older adults with diabetes must take this heterogeneity into consideration when setting and prioritizing treatment goals. The diet should not be high in saturated fat. Several studies have reported a modestly increased risk of incident diabetes with statin use, which may be limited to those with diabetes risk factors. Older adults are at higher risk of hypoglycemia for many reasons, including insulin deficiency necessitating insulin therapy and progressive renal insufficiency.

Pregabalin is the most extensively studied drug for this purpose, and duloxetine has also shown efficacy. C, 10.21 In patients with diabetes at higher risk, especially those with multiple ASCVD risk factors or aged 50–70 years, it is reasonable to use high-intensity statin therapy. A. B, 9.12 The medication regimen and medication-taking behavior should be reevaluated at regular intervals (every 3–6 months) and adjusted as needed to incorporate specific factors that impact choice of treatment (Figure 4.1 and Table 9.1). E. “13. B, 12.13 Deintensification (or simplification) of complex regimens is recommended to reduce the risk of hypoglycemia and polypharmacy, if it can be achieved within the individualized A1C target. 5.24 Children and adolescents with type 1 or type 2 diabetes or prediabetes should engage in 60 min/day or more of moderate- or vigorous-intensity aerobic activity, with vigorous muscle-strengthening and bone-strengthening activities at least 3 days/week. 14.14 Insulin is the preferred medication for treating hyperglycemia in GDM. It should be assessed and managed by adjusting glycemic targets and pharmacologic regimens. Follow-up of three large studies of lifestyle intervention for diabetes prevention has shown sustained reduction in the rate of conversion to type 2 diabetes: 39% reduction at 30 years in the Da Qing Diabetes Prevention Study, 43% reduction at 7 years in the Finnish Diabetes Prevention Study, and 34% reduction at 10 years and 27% reduction at 15 years in the U.S. Diabetes Prevention Program Outcomes Study. In the critical care setting, continuous intravenous insulin infusion is the best method for achieving glycemic targets.

It includes delivery systems such as insulin pumps, pens, and syringes as well as CGM devices and glucose meters. B, 4.5 Ongoing management should be guided by the assessment of diabetes complications and shared decision-making to set therapeutic goals. Follow us on Twitter, Facebook, YouTube and LinkedIn, ADA Members, please use the email address linked to your membership, Notice: Multiple failure attempts will cause account suspension. B. Patients found to have elevated blood pressure (≥140/90 mmHg) should have blood pressure confirmed using multiple readings, including measurements on a separate day, to diagnose hypertension.

Therefore, the combined use of an ACE inhibitor and an ARB should be avoided. Those who are determined to be at high risk for type 2 diabetes, including people with an A1C of 5.7–6.4% (39–47 mmol/mol), impaired glucose tolerance, or impaired fasting glucose, are ideal candidates for diabetes prevention efforts. Requests to reuse or repurpose; adapt or modify; or post, display, or distribute this work may be sent to permissions{at} The ADA guidelines still recommend Metformin as the first drug for patients with diabetes type 2 (DM2).

While hypoglycemia is associated with increased mortality, it may be a marker of underlying disease rather than the cause of fatality. Early combination therapy can be considered in some patients at treatment initiation to extend the time to treatment failure. Once SMBG returns to normal, the individual should consume a meal or snack to prevent recurrence of hypoglycemia. The American College of Cardiology’s designated representatives (for Section 10) were Sandeep Das, MD, MPH, FACC, and Mikhail Kosiborod, MD, FACC. E, 6.14 Hypoglycemia unawareness or one or more episodes of level 3 hypoglycemia should trigger hypoglycemia avoidance education and reevaluation of the treatment regimen.

See “15.

Reprinted with permission from Vassalotti JA, Centor R, Turner BJ, Greer RC, Choi M, Sequist TD; National Kidney Foundation Kidney Disease Outcomes Quality Initiative. B.

Older adults with diabetes are likely to benefit from control of other CV risk factors, with treatment of hypertension to individualized target levels indicated in most. If the patient has established or risk factors for cardiovascular disease, then a GLP1 agonist with proven CVD benefits is the recommended second-line medication. The abridged version does not include references. ASCVD—defined as coronary heart disease, cerebrovascular disease, or peripheral arterial disease (PAD) presumed to be of atherosclerotic origin—is the leading cause of morbidity and mortality for individuals with diabetes. C, 11.38 Provide general preventive foot self-care education to all patients with diabetes. The diagnostic criteria for diabetes and prediabetes are shown in Table 2.2/2.5. Once initiated, metformin should be continued as long as it is tolerated and not contraindicated; other agents, including insulin, should be added to metformin.

B, 1.4 Assess diabetes health care maintenance using reliable and relevant data metrics to improve processes of care and health outcomes, with simultaneous emphasis on care costs. C, 12.6 Glycemic goals for some older adults might reasonably be relaxed as part of individualized care, but hyperglycemia leading to symptoms or risk of acute hyperglycemia complications should be avoided in all patients.

Nonprofit websites can offer advice for providers and patients to determine the suitability of various options.

C, 8.9 For patients who achieve short-term weight-loss goals, long-term (≥1 year) weight maintenance programs are recommended when available.

C, 10.28 Statin therapy is contraindicated in pregnancy.

C. Patients with or without diabetes may experience hypoglycemia in the hospital setting. 3.2 Refer patients with prediabetes to an intensive behavioral lifestyle intervention program modeled on the Diabetes Prevention Program (DPP) to achieve and maintain 7% loss of initial body weight and increase moderate-intensity physical activity (such as brisk walking) to at least 150 min/week. 14.15 Metformin, when used to treat polycystic ovary syndrome and induce ovulation, should be discontinued by the end of the first trimester. A plan for preventing and treating hypoglycemia should be established for each patient. C. Numerous large, randomized controlled trials have reported statistically significant reductions in CV events for three of the FDA-approved SGLT2 inhibitors (empagliflozin, canagliflozin, and dapagliflozin) and four FDA-approved GLP-1 receptor agonists (liraglutide, albiglutide [although that agent was removed from the market for business reasons], semaglutide [lower risk of CV events in a moderate-sized clinical trial but one not powered as a CV outcomes trial], and dulaglutide). Community resources and policies (identifying or developing resources to support healthy lifestyles), 6. SDoH are defined as the economic, environmental, political, and social conditions in which people live and are responsible for a major part of health inequality worldwide. B Prolonged sitting should be interrupted every 30 min for blood glucose benefits. The complete 2020 Standards of Care, including all supporting references, is available at This section has received endorsement from the American College of Cardiology. Metformin is contraindicated for use in patients with an eGFR <30 mL/min/1.73 m2. E, 8.13 Weight-loss medications are effective as adjuncts to diet, physical activity, and behavioral counseling for selected patients with type 2 diabetes and BMI ≥27 kg/m2.

B, 8.12 Whenever possible, minimize medications for comorbid conditions that are associated with weight gain.

B, 10.2 All hypertensive patients with diabetes should monitor their blood pressure at home. B, 3.9 Diabetes self-management education and support (DSMES) programs may be appropriate venues for people with prediabetes to receive education and support to develop and maintain behaviors that can prevent or delay the development of type 2 diabetes.

An individualized eating pattern considers the individual’s health status, skills, resources, food preferences, and health goals.

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