This transcript has been edited for clarity.
It's that time of year again. I know we're starting 2025, but just before the new year changed, we had the publication of the updated ADA Standards of Care. I'm going to go through some of the things I think are important in the Standards of Care in Diabetes—2025 and then encourage you to review them on your own to see what you think is new and interesting.
I've made three videos, this being the first, that go through the entire document and hopefully simplify what the new concepts are. I'm going to start going section by section, and I'm going to do this in three parts. This is part 1.
Section 1 is entitled Improving Care and Promoting Health and Populations.I think this section, although it seems less prescriptive than others, is actually very important. It has evolved over time to talk about the importance of the social determinants of health and understanding the environments in which our patients live and work so we can help them manage their diabetes better.It also now talks about cost and affordability, and how that interplays with health disparities and our ability to help our patients.
Section 2 is entitled Diagnosis and Classification of Diabetes. I finally feel like I've won the lottery because I've spent the past several years discussing that people with diabetes can have both type 1 and type 2 diabetes, or at least elements of both that make it complicated to manage them. You're basically managing, say, type 1 diabetes with a metabolic syndrome or insulin-deficient type 2 diabetes, which you manage like for somebody with type 1.
In these guidelines, they say that classification can be difficult and there are people who have both type 1 and type 2 diabetes. Over time, as we progress in our ability to define types of diabetes, it will become clearer who has what. For now, it's okay to characterize somebody with both type 1 and type 2 diabetes and treat them according to what they need rather than just an assigned label as to diabetes type.
In terms of screening, they reinforce the importance of antibody-based screening for people with presymptomatic type 1 diabetes who have a strong family history of type 1 diabetes. They also updated the section on gestational diabetes to align more closely with what is available in terms of the international criteria for the diagnosis and treatment of gestational diabetes.
Section 3 discusses the prevention or delay of diabetes and associated comorbidities. I think the one thing that's really different is that they include discussions about sleep and how important it is for people with prediabetes, type 2 diabetes, and, frankly, all of us, to have a healthy lifestyle.
Section 4 is about a comprehensive medical evaluation and comorbidity assessment in people with diabetes. I'm going to start by saying that they give us many really good recommendations. I'm also going to tell you that there are so many recommendations that it becomes a bit overwhelming, especially for a specialist, like I am, who is trying to do everything for my patients with diabetes but frankly can't in a 15-minute encounter.
They really go through the detail of what an initial follow-up and annual visit should entail. They added a new subsection, “Dental Care,” with two new recommendations. They also discussed that people should have an assessment of disability at the initial exam and then as needed over time.They talk about sexual health in both men and women.
The next portion of this is all about screening and following patients with metabolic dysfunction‒associated steatotic liver disease — MASLD, or MASH, which is easier to say. They have a wonderful figure, Figure 4.2, which goes through how to do the screening to see who's at higher risk or lower risk for cirrhosis.
I would argue that this is a great figure that is easy to follow. I think it's important to consider this in our patients with diabetes, particularly patients who are obese, but also those with prediabetes and type 2 diabetes. I have long screened patients for liver disease and I have never quite as consciously considered who's at lower and higher risk for cirrhosis. I think this pathway is helpful in assessing that and then determining which patients should be referred to a specialist.
They also have another figure looking at the different treatments for MASLD.Again, to me, this is really new territory. I find it fascinating because, even though I've been doing many of these things without really thinking about it in this way, this lists what we're doing as we treat these patients at risk for progressive cirrhosis and liver disease. It discusses obesity therapy, diabetes therapy, and specific pharmacotherapy for MASH now that we have a treatment that can be used.
Even though it seems like there's so much to think about with each patient with diabetes, it's certainly something that, if we do, we can really help our patients. It also, though, points out the need to work as a team. I can't do all of this by myself for any one patient with diabetes.
I personally manage mostly abnormalities of glucose.I'm treating many people with type 1 diabetes or complex type 2 diabetes. In the 15 minutes I have to see each patient, I can't do many of these other things. However, these other things need to be done.
I need to be sure the patients had their labs drawn. I need to be sure they're onappropriate medications for cardiovascular risk modification. I need to be sure that someone's assessing them for MASH. I need to be sure that I'm working with a certified diabetes care and educational specialist so that patients can get the education they need. I need to think about the psychosocial issues.
There are many things here, and all of them should be considered. I'm not sure that any one of us can do each of the things required for the management and evaluation of our patients with diabetes.
That's the end of the first video. In the next video, we'll continue to explore the other sections.
COMMENTARY
Classifying and Managing Diabetes the Focus in 2025 Standards of Care
DISCLOSURES
| January 15, 2025This transcript has been edited for clarity.
It's that time of year again. I know we're starting 2025, but just before the new year changed, we had the publication of the updated ADA Standards of Care. I'm going to go through some of the things I think are important in the Standards of Care in Diabetes—2025 and then encourage you to review them on your own to see what you think is new and interesting.
I've made three videos, this being the first, that go through the entire document and hopefully simplify what the new concepts are. I'm going to start going section by section, and I'm going to do this in three parts. This is part 1.
Section 1 is entitled Improving Care and Promoting Health and Populations.I think this section, although it seems less prescriptive than others, is actually very important. It has evolved over time to talk about the importance of the social determinants of health and understanding the environments in which our patients live and work so we can help them manage their diabetes better.It also now talks about cost and affordability, and how that interplays with health disparities and our ability to help our patients.
Section 2 is entitled Diagnosis and Classification of Diabetes. I finally feel like I've won the lottery because I've spent the past several years discussing that people with diabetes can have both type 1 and type 2 diabetes, or at least elements of both that make it complicated to manage them. You're basically managing, say, type 1 diabetes with a metabolic syndrome or insulin-deficient type 2 diabetes, which you manage like for somebody with type 1.
In these guidelines, they say that classification can be difficult and there are people who have both type 1 and type 2 diabetes. Over time, as we progress in our ability to define types of diabetes, it will become clearer who has what. For now, it's okay to characterize somebody with both type 1 and type 2 diabetes and treat them according to what they need rather than just an assigned label as to diabetes type.
In terms of screening, they reinforce the importance of antibody-based screening for people with presymptomatic type 1 diabetes who have a strong family history of type 1 diabetes. They also updated the section on gestational diabetes to align more closely with what is available in terms of the international criteria for the diagnosis and treatment of gestational diabetes.
Section 3 discusses the prevention or delay of diabetes and associated comorbidities. I think the one thing that's really different is that they include discussions about sleep and how important it is for people with prediabetes, type 2 diabetes, and, frankly, all of us, to have a healthy lifestyle.
Section 4 is about a comprehensive medical evaluation and comorbidity assessment in people with diabetes. I'm going to start by saying that they give us many really good recommendations. I'm also going to tell you that there are so many recommendations that it becomes a bit overwhelming, especially for a specialist, like I am, who is trying to do everything for my patients with diabetes but frankly can't in a 15-minute encounter.
They really go through the detail of what an initial follow-up and annual visit should entail. They added a new subsection, “Dental Care,” with two new recommendations. They also discussed that people should have an assessment of disability at the initial exam and then as needed over time.They talk about sexual health in both men and women.
The next portion of this is all about screening and following patients with metabolic dysfunction‒associated steatotic liver disease — MASLD, or MASH, which is easier to say. They have a wonderful figure, Figure 4.2, which goes through how to do the screening to see who's at higher risk or lower risk for cirrhosis.
I would argue that this is a great figure that is easy to follow. I think it's important to consider this in our patients with diabetes, particularly patients who are obese, but also those with prediabetes and type 2 diabetes. I have long screened patients for liver disease and I have never quite as consciously considered who's at lower and higher risk for cirrhosis. I think this pathway is helpful in assessing that and then determining which patients should be referred to a specialist.
They also have another figure looking at the different treatments for MASLD.Again, to me, this is really new territory. I find it fascinating because, even though I've been doing many of these things without really thinking about it in this way, this lists what we're doing as we treat these patients at risk for progressive cirrhosis and liver disease. It discusses obesity therapy, diabetes therapy, and specific pharmacotherapy for MASH now that we have a treatment that can be used.
Even though it seems like there's so much to think about with each patient with diabetes, it's certainly something that, if we do, we can really help our patients. It also, though, points out the need to work as a team. I can't do all of this by myself for any one patient with diabetes.
I personally manage mostly abnormalities of glucose.I'm treating many people with type 1 diabetes or complex type 2 diabetes. In the 15 minutes I have to see each patient, I can't do many of these other things. However, these other things need to be done.
I need to be sure the patients had their labs drawn. I need to be sure they're onappropriate medications for cardiovascular risk modification. I need to be sure that someone's assessing them for MASH. I need to be sure that I'm working with a certified diabetes care and educational specialist so that patients can get the education they need. I need to think about the psychosocial issues.
There are many things here, and all of them should be considered. I'm not sure that any one of us can do each of the things required for the management and evaluation of our patients with diabetes.
That's the end of the first video. In the next video, we'll continue to explore the other sections.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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