COMMENTARY

Key Points in the ADA's New Diabetes Guidelines

Anne L. Peters, MD

Disclosures

January 21, 2014

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New ADA Standards of Care: A Gradual Evolution

Hi. I am Dr. Anne Peters, and today I am going to talk about the American Diabetes Association (ADA) 2014 Standards of Medical Care in Diabetes.[1] These standards of care aren't dramatically different from previous standards of care. These standards are the result of a gradual evolution of knowledge that we have gained from year to year. It is important to review the key points each year and talk about what is different.

Another important point about these standards is that increasingly standards from different organizations are different with respect to patient management. For example, the American Heart Association (AHA) guidelines for the treatment of a lipid disorder in a patient with diabetes is now somewhat different from the ADA guidelines. Guidelines for the treatment of hypertension are increasingly different. Screening for something as basic as gestational diabetes has 2 different approaches.

Still Individualizing After All These Years

We need to reconcile, within ourselves, the knowledge from the different guidelines and how they fit for each of our patients, and then come up with individualized care for each patient, which is a key theme of these guidelines.

As a practitioner, I bristle at the suggestion that perhaps I haven't been individualizing care for my patients all of these years, but I realize that it is important for everyone -- from patients to providers to the insurers and to the people who are measuring our outcomes -- to recognize how important it is to assess each patient and his or her situation and needs, to determine what is best for that patient and to proceed from there.

It is very important that we think about such things as A1c targets at an individual level. It is very important to keep the A1c level as close to normal as we safely can, but that is going to vary according to the patient's clinical circumstances, age, risk for hypoglycemia, and many other factors.

Therefore, even though I think I am a good diabetes doctor, I know that I have patients whose A1c levels are 10%, which, for complicated reasons, I can't get them lower. I also have many patients who are at target and whose A1c levels are < 7% -- and in some cases safely < 6% -- so I am willing to admit that I individualize targets. Hopefully all of you will as well. I refer you to the 2014 standards of care and to read them more fully so you can familiarize yourself with the recommendations.

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