The American Diabetes Association (ADA) issued its guidelines for its Standards of Care in Diabetes for 2024. The intent of the ADA is to ensure that the Standards of Care will provide clinicians, patients, researchers, health plans, and policymakers with up-to-date information on diabetes care, general treatments, and tools to evaluate the quality of care. The following is a summary of some of the key updates addressed in the 2024 ADA Guidelines:4
- Updates in guidance on the diagnosis and classification of diabetes:
- Tables for testing criteria to diagnose diabetes were modified to include A1C at the top of the testing hierarchy to align with real-world practice when diagnosing diabetes and prediabetes.
- Emphasis on the importance of classifying patients with hyperglycemia; this differentiation of which form of diabetes an individual has will facilitate personalized management.
- Standardized islet autoantibody tests are recommended for the classification of diabetes in adults who have risk factors that overlap with those for type 1 diabetes (e.g., younger age at diagnosis, weight loss, ketoacidosis).
- Testing for prediabetes or type 2 diabetes in asymptomatic patients should be considered in adults who are overweight or obese and have one or more risk factors (e.g., physical inactivity, hypertension, family history, previously diagnosed with GDM).
- Screen for GDM at 24-28 weeks of gestation in pregnant individuals not previously found to have diabetes or high-risk abnormal glucose metabolism earlier in the current pregnancy.
- Screen individuals with GDM at 4-12 weeks postpartum.
- Screening recommendations for heart failure in people with diabetes: An elevated blood pressure (systolic 120-129 mmHg and diastolic <80 mmHg) should have multiple readings over several days to assess for hypertension. Hypertension is defined as systolic blood pressure above 130 mmHg or a diastolic above 80 mmHg based on two or more measurements.
- Management of obesity in people with diabetes: Updated weight management will include incorporating additional obesity measurements beyond body mass index (i.e., waist circumference, waist-to-hip ratio, and/or waist-to-height ratio). For people with type 2 diabetes who are overweight or obese, weight management should represent a primary goal of treatment along with glycemic management.
- More guidance on the use of new obesity medications: Prioritized use of glucagon-like peptide 1 (GLP-1) agonists or dual glucose-dependent insulinotropic polypeptide (GIP) receptor agonists to reach sustained weight management goals. These are the preferred medications for diabetic patients who are overweight or obese due to glucose-lowering properties and a beneficial effect on weight.
- New information on the possible association between COVID-19 infections and new onset of type 1 diabetes:
- New-onset diabetes cases should receive routine follow-up to determine if the condition is transient. The mechanism for this association is unknown at this time but may include previously undiagnosed diabetes presenting during the disease, stress hyperglycemia, steroid-induced hyperglycemia, and possibly direct or indirect effects of SARS-CoV-2 on the beta cells.
- People with diabetes who have been infected with SARS-CoV-2 should be followed up in the longer term to assess complications and symptoms of long COVID-19. Approximately 30-40% of people who are infected with COVID-19 and are diabetic have long COVID-19.
