3 Major Changes in New Diabetes Guidelines

New diabetes guidelines change BMI cutoff for Asian-Americans, individualize glucose goals and require more statins

(RxWiki News) As medicine evolves, the health care community must keep up with the newest ideas. For patients with diabetes, some recent changes may be important.

The American Diabetes Association (ADA) recently published new guidelines for treating diabetes. A recent commentary highlighted three important changes to the guidelines.

This commentary was written by Giulio R. Romeo, MD, and Martin J. Abrahamson, MD, of the Joslin Diabetes Center and Beth Israel Deaconess Medical Center in Boston.

"The common motif of the 2015 Standards is the continued emphasis of individualizing therapeutic decisions based on factors that include ethnicity, overall risk for [heart disease], life expectancy, [other] conditions, the patient’s preferences and goals, and his or her ability to adhere to treatment regimens," Drs. Romeo and Abrahamson wrote. "Once more, the patient takes the center stage."

David Winter, MD, chief clinical officer, president and chairman of the board of HealthTexas Provider Network, a division of Baylor Health Care System, said most doctors who work with diabetes patients already employ the principles in these new guidelines.

"Good control of diabetes is important as it has been shown to reduce long term complications," Dr. Winter told dailyRx News. "Optimal control requires a patient to work closely with their physician, managing diet, exercise and medication in concert. Ideally, the patient, under tutelage from the physician, becomes the expert in their own care."

Diabetes is a complex disease caused by an inability to control blood sugar. It is divided into two types. Type 1 patients cannot make the hormone insulin, which helps remove glucose (sugar) from the blood. Type 2 patients successfully make insulin, but their cells are not responsive to it. Both situations can cause high blood sugar. If untreated, it can lead to many other symptoms, such as kidney damage and heart problems.

The ADA recommends certain guidelines for the treatment of diabetes. As more information is gathered, the standards evolve. There were three major changes in the newest guidelines from the ADA:

New BMI Cutoff for Asian-Americans

Traditionally, a body mass index (BMI) over 30 is considered obese, and anyone with a BMI over 25 is considered at risk for diabetes. However, Asian-Americans with diabetes typically have a lower BMI than other Americans with diabetes. This is because Asian-Americans often have a higher level of visceral fat than other groups.

As a result, even if their height and weight appear to be healthy, there may still be an unhealthy level of fat beneath the surface. To adjust for this genetic predisposition, the guidelines have been adjusted. The cutoff point when assessing diabetes risk in this population should be lowered from 25 to 23, Drs. Romeo and Abrahamson wrote.

Blood Glucose Goals Should Take Many Factors into Account

Controlling blood glucose can be a difficult task. For this reason, the new guidelines recommend that goals for blood glucose levels should not be one-size-fits-all. They should take into account many aspects of a patient's life.

Drs. Romeo and Abrahamson wrote that "age, [other] conditions, life expectancy, and the patient’s motivation and preferences" should be taken into consideration.

Average blood sugar is measured by blood levels of A1C hemoglobin, a protein that binds glucose. It is usually recommended that patients with diabetes keep these levels at less than 7 percent.

However, a stricter goal of less than 6.5 percent should be recommended in recently diagnosed diabetes patients with long life expectancy and no significant heart disease, Drs. Romeo and Abrahamson said. In other cases, a goal of less than 8 percent may actually be a better option if patients already have significant complications and limited life expectancy.

Statins Are Important for Heart Health

Statins (such as Lipitor and Crestor) are medications used to lower cholesterol. They have consistently been shown to decrease the risk of heart disease — a common complication of diabetes. Drs. Romeo and Abrahamson said statins should be suggested for all diabetes patients who are older than 40.

Precautionary statins are now even recommended in some cases where cholesterol levels appear to be normal.

These guidelines were published online March 24 in the Annals of Internal Medicine.

Dr. Abrahamson received personal fees from Novo Nordisk, WebMD Health Services and Amgen.

Review Date: 
March 23, 2015