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ADA Releases New Standards of Medical Care: All People with Diabetes Should Use Statins, and More Asian Americans Should Be Screened for Diabetes

Twitter Summary: @AmDiabetesAssn updates standards for medical care of #diabetes – suggests all #PWD use statin therapy, and a new BMI cutoff for Asian Americans

The American Diabetes Association (ADA) recently released its updated Standards of Medical Care, providing guidance on the diagnosis and treatment of diabetes. Notably, the guidelines recommend that all people with diabetes should receive statin therapy. As background, statins are a drug class that work to lower LDL cholesterol (the “bad” kind) by blocking the liver’s cholesterol production. The ADA now recommends that people with diabetes under 40 years old or who are 40 to 75 years old with no additional heart risk factors take a moderate-intensity statin. For those between the ages of 40 and 75 with additional cardiovascular risk factors (e.g. high blood pressure, high cholesterol, etc.), a high-intensity statin is recommended. The previous ADA Standards of Medical Care recommended that low-risk individuals (those without heart disease or anyone under 40) take statins only if they had an LDL cholesterol level above 100 mg/dL or multiple other heart disease risk factors. These new guidelines reflect the notion that all people with diabetes are at increased risk for heart complications, and thus statin therapy is recommended even for those within a healthy LDL cholesterol range.

Another major change is the recommendation for Asian Americans with a body mass index (BMI) of 23 or above to be screened for type 2 diabetes. For the general population, the BMI cutoff for type 2 diabetes screening is 25, at which point someone is classified as overweight. However, significant evidence shows that people from Asian American populations on average develop diabetes at lower BMIs; this recommendation could help to identify more of the 8.1 million people with undiagnosed diabetes.

Other recommendations include a new section on diabetes in pregnancy, revised immunization guidelines for older adults, a statement that e-cigarettes are not supported by the ADA as an alternative to smoking (that would be pretty scary!) or as a method to quit smoking, and a reiteration of the <7.5% A1c target for children and adolescents that was released by the ADA last summer. The latter has been controversial, but the ADA has been steadfast in its assertion that children and teens seem to get hypoglycemia just as often at A1cs between 8% and 8.5% (the previous guideline for many kids) as they do at A1cs between 7% and 7.5% (and these lower A1cs are safer from a long-term complications perspective). To read the full guidelines, please see this link. –AJW/MA