Based on high risk for developing cardiovascular disease, the new American Diabetes Association (ADA) guideline published in Diabetes Care recommends all diabetics ages 40 to 75 take at least moderate-intensity statin therapy.
In June 2014, experts at the ADA's annual meeting expressed concern over the national guidelines released by the American College of Cardiology/American Heart Association (ACC/AHA) for lipid management. But the new annual update to the ADA's Standards of Medical Care now falls in line with the ACC/AHA recommendations.
"The big change here is to recommend starting either moderate- or high-intensity statins based on the patient's risk profile rather than on LDL [low-density lipoprotein] level. Since all patients with diabetes are at high risk, it is just a matter of deciding whom to start on moderate- versus high-intensity statin doses," Richard W. Grant, MD, MPH, a research scientist at Kaiser Permanente and chair of the ADA's Professional Practice Committee, said in a press statement.
And all diabetic patients with cardiovascular disease, and those 40 to 75 years old who have any other risk factor for cardiovascular disease, should be placed on high-intensity statin therapy.
"Treatment initiation (and initial statin dose) is now driven primarily by risk status rather than LDL cholesterol level," the committee wrote.
Another change in the ADA guidelines is a loosening of the diastolic blood pressure target, from 80 mmHg to 90 mmHg, in patients with diabetes. And the new document makes a slight change to glycemic targets for pre-meal blood glucose, to 80-130 mg/dL instead of the previous 70-130 mg/dL.
A completely new recommendation in the 14-section document known as the Standards of Medical Care, formerly the "Clinical Practice Recommendations," addressed physical activity not only for patients with diabetes but for the population as a whole.
Regular exercise was chief among the points, but the new guideline also now calls for people to get up and move around every 90 minutes or less during sedentary periods. For patients with diabetes in particular, the recommendations included resistance training at least twice per week in addition to other regular exercise.
Other changes to the ADA's Standards included lowering the BMI cutpoint for diabetes screening in Asian Americans from 25 kg/m² to 23 kg/m², due to research suggesting this population has a higher body fat percentage when compared with other races and ethnicities with the same BMI. Asian Americans also tend to carry excess weight around the waistline compared with peripheral limb fat storage, the report stated.
These new recommendations were consistent with the American Association of Clinical Endocrinologists and the American College of Endocrinology 2014 Advanced Framework for a New Diagnosis of Obesity as a Chronic Disease, which promoted a comprehensive approach, including ethnicity-based adjustments for BMI cutpoints, based on waist circumference among other metabolic risk factors.
A new section was added to this year's Standards for the management of diabetes during pregnancy. Within this section, the ADA recommends a one-step screening test for gestational diabetes.
For children and adolescents with diabetes, the new Standards recommend an HbA1c (glycated hemoglobin) target of less than 7.5%. This is consistent with an ADA position statement released earlier in 2014.
"We've revised our recommendations, as we do every year, to reflect the best and most current research affecting the treatment and care of people with diabetes," Jane Chiang, senior vice president of the ADA's Medical Affairs and Community Information division, said in a press statement.
"Healthcare providers know that the Association Standards contain the most up-to-date information. However, we wanted to help readers navigate through the information overload and felt that a new format would enable easier access," she said.
From the American Heart Association:
Rich pickings for Big Pharma then,