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New Diabetes Guidelines: New Focus on Weight Loss, Sleep and Continuous Glucose Monitors

 The American Diabetes Association (ADA) released guidance this week outlining new standards for diabetes care.

Though the guidance is updated annually, this year’s tweaks are more extensive than usual and include stricter recommendations related to medications, new technologies, weight control, and modifiable lifestyle factors like sleep and exercise.

The guidance also aims to improve health inequities by screening at-risk populations for food and housing insecurity and connecting them with community resources.

The authors hope the new standards of care will be used by clinicians, diabetes care specialists, and policymakers as the go-to source for diabetes care.

“The updates in the 2023 Standards of Care are a testament to how far we’ve come as a medical community, in terms of better medications/technologies enabling more aggressive targets for health, and in terms of being more aware of health disparities,” Dr. David Ahn, an endocrinologist and program director of the Mary & Dick Allen Diabetes Center at Hoag Hospital, told Healthline.

A heightened focus on weight control 

This year’s guidance heavily focuses on the importance of weight control and stresses that weight loss can lead to diabetes remission and long-term cardiovascular improvements.

Obesity is a risk factor for diabetes and can contribute to health complications like high blood pressure, high cholesterol, and high glucose levels.

We have new, more effective obesity medications available along with tools that can help patients better manage their glucose levels.

“Recent advances in diabetes medications have enabled people with diabetes to achieve more weight loss, and in turn, better diabetes control, than ever before,” Ahn said.

Dr. Thomas Grace, a family medicine doctor specializing in diabetes and medical director of the Blanchard Valley Diabetes Center, says the increased focus on weight loss has been very important.

“Ultimately, diabetes is easier to control as people are on the path to losing weight,” Grace said.

Highlighting new technologies

The new guidance focuses on the use of new technologies that have helped improve diabetes care — such as telehealth, digital health, and telemedicine.

In addition, new evidence supporting the use of continuous glucose monitors (CGM) was included with the goal of improving access to CGM use.

According to the guidance, diabetes technology is rapidly evolving — and, sometimes, insurance coverage lags behind, making it difficult for patients to access and afford the care.

“We have new medications and technologies every few years that revolutionize how we care for people with diabetes,” Grace said.

Modifying lifestyle factors like sleep and exercise 

The guidance also includes new recommendations related to modifiable lifestyle factors, including sleep and exercise.

The recommendations suggest that diabetes patients should be screened for sleep health and referred to a sleep specialist if they experience regular sleep issues.

“Sleep is often under-recognized as a contributor to higher blood sugar and weight gain,” Ahn said, adding that untreated sleep conditions like sleep apnea can contribute to high blood pressure and higher blood sugar levels.

A healthy diet, regular physical activity, good sleep hygiene, psychological well-being, tobacco cessation are essential for diabetes care, according to the guidance.

Routine evaluation of patients’ health behaviors is necessary to optimize diabetes care, the guidance suggests.

Acknowledging and correcting racial discrepancies 

New strategies for addressing racial inequities are included in the new standards of care.

Health inequities related to diabetes are well-documented — Alaskan Native, Black, and Hispanic people have a greater risk for diabetes and experience poorer health outcomes.

In addition, diabetes medications, like insulin, can be expensive, further contributing to health disparities across the United States, says Grace.

The document suggests that at-risk populations be screened for food insecurity, housing insecurity, financial barriers, and community support.

In addition, patients should be referred to community workers or health coaches who can help support their care and management of risk factors.

The bottom line:

The American Diabetes Association released guidance this week outlining new standards for diabetes care. The report includes recommendations related to medications, new technologies, weight control, and modifiable lifestyle factors like sleep and exercise. It also includes steps for reducing health inequalities related to diabetes care and health outcomes.

By: Healthline