In an education session during APhA2022 titled "Know the Facts: Annual Diabetes Update," Susan Cornell, PharmD, CDCES, FAPhA, FADCES, summarized changes to the American Diabetes Association Standards of Medical Care in Diabetes, described emerging trends in disease management, and covered therapeutic decision making when treating patients with diabetes.

Dr. Cornell, associate director of experiential education/professor of pharmacy practice Midwestern University College of Pharmacy Downers Grove, began the session by acknowledging the considerable impact of the pandemic on diabetes treatment. "Post COVID-19," she said, "we have some work to do. Unfortunately, we have seen an uptick in people with diabetes, which is no surprise."

What is surprising, Dr. Cornell reported, is a shift in the populations diagnosed with diabetes. "We are seeing more and more people with type 2 diabetes (T2D) being diagnosed at an earlier age and more people with type 1 diabetes (T1D) being diagnosed at an older age. "In fact, she continued, we are "seeing 40% to 50% of people with T1D with obesity."

"It's not just about T2D," she pointed out. "People with T2D need management and care." Recently, she reported, some T2D medications are being used in T1D as adjuncts to insulin and lifestyle changes.

Citing the CDC National Diabetes Statistics Report–2022, she said that a key finding is that more people are developing T1D and T2D during their youth. New cases of diabetes, she explained, have decreased in the past 10 years, except for people younger than age 20 years.

Dr. Cornell mentioned other pertinent statistics from the CDC report, including that 37.3 million Americans, or 11.3% of the population, have diabetes, and 96 million American adults, or 38% of the U.S. population, have prediabetes. In addition, she said, new diabetes cases were higher among non-Hispanic blacks and people of Hispanic origin, and racial and ethnic minorities continue to develop T2D at higher rates. Other key emerging statistics are that 45.8% of people with diabetes had obesity; 15.5% had extreme obesity; and 50.0% had an A1C value of 7.0% or higher.

In the ADA Summary of Revisions: Standards of Medical Care in Diabetes–2022, Section 4, "Comprehensive Medical Evaluation & Assessment of Comorbidities," Dr. Cornell said, the immunization subsection was updated to include COVID vaccine information and provide more evidence on the benefits of the influenza vaccine in people with diabetes and cardiovascular disease.

Other noteworthy revisions to the ADA Standards of Medical Care in Diabetes–2022 include terminology changes, including the term "blood glucose monitoring (BGM) replacing the term self-monitoring of blood glucose" (SMBG). "CGM [continuous glucose monitoring] use to improve the management of diabetes continues to expand. Get comfortable with it, because it is out future," she said. Also, she noted, the term "smart pens" was replaced with "connected insulin pens" in the latest revision.

In the session, Dr. Cornell also emphasized that lifestyle, including self-care, is the cornerstone to optimal diabetes therapy and outcomes. "We can't underestimate the power of making health lifestyle choices," she said.

Practitioners currently can initiate combination therapy upon a diagnosis of T2D. "Based on T1D guidelines, multiple daily injections of a long-acting basal analog plus rapid- or ultra rapid–acting bolus analog is the preferred injectable insulin regimen," Dr. Cornell stated.

Additionally, another key takeaway from the session is that metformin is no longer the only first-line agent. "We can use GlP1s or SGLT2 inhibitors; it may take time to get used to, but the bottom line is that it is there. We need to move beyond glycemic lowering. It is not just about sugar anyone. We have to look at everything else going on with the patient."

In addition, the latest guidelines maintain a sharp focus on pregnant patients. "The recommended target glucose range for pregnant women with diabetes," she noted, "is defined as 63-140 mg/dL." Finally, Dr. Cornell reported that the latest guidelines define a hypoglycemic level 3 event as an altered mental and/or physical status requiring assistance.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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