The ADA made updates in their guidance regarding sleep and exercise. They now advise healthcare providers to screen patients and see if they suffer from food insecurity. The guidelines has a new set of goals in terms of fitness, weight, blood pressure, and sleep.
The American Diabetes Association (ADA) recently released the 2023 Standards of Care in Diabetes. This set are updated each year after the experts review each criteria in the list. As for this year, the updates made hone in on how to more aggressively treat and reduce diabetes complications. They made changes and adjustments when it comes to weight loss, high blood pressure, cholesterol, and the like.
“The world of diabetes is moving quite quickly. There are lots of new studies, and we want to make sure clinicians have the most up-to-date information to guide them in how to care for people with diabetes,” says Robert A. Gabbay, MD, PhD. He is the chief scientific and medical officer of the ADA.
This guidelines were released on December 2022 and is considered to be the gold standard of care. That’s because experts use this daily. In fact, they accessed the list four million times last year, as per Dr. Gabbay.
New Standards Made Support Higher Weight Loss Goals
The most recent set of guidelines emphasizes higher weight loss goals. They say that this can go as high as 15 percent. That is, considering that the person can also get the prescribed newer medications and responds well to these.
“The shift in thinking is to not just consider glucose control, which is what diabetes has always been about. But for people with obesity, which is the majority of people with type 2 diabetes, one needs to think about weight management,” said Gabbay.
As a matter of fact, mild weight loss is effective when it comes to reducing type 2 diabetes burden. The previous recommendations set a 5 percent goal. However, with more weight loss goes hand in hand the lowering of illness and death. Gabbay said, “And we now have some potent agents that can help people achieve their weight loss goals.”
“The newer medications, specifically GLP-1 receptor agonists [such as Ozempic and Wegovy] and SGLT2 inhibitors [like Jardiance and Farxiga], have made a profound impact on both glycemic and weight management in individuals with T2D,” said Donald McClain, MD, PhD. He is a professor of endocrinology and metabolism at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Dr. McClain is also the director of the Center on Diabetes, Obesity, and Metabolism at Atrium Health Wake Forest Baptist. However, he was not part of the group that updated the standards.
In general, the medications alone are associated with significant weight loss, close to 25 pounds or even more, he says.
Lower Is Better in Terms of New Goals for Blood Pressure and LDL Cholesterol
One of the most crucial update concerns blood pressure, said Gabbay. “The goal has been lowered to less than 130 over 80, a change that was prompted by the evidence showing that people have significantly better outcomes when blood pressure is managed below that level,” he explained.
This goal goes with the current recommendation by the American Heart Association and the American College of Cardiology.
The recommended goals for LDL cholesterol (which is known as the “bad” cholesterol because too much of this can build in the arteries and increase the chances of a heart disease) has also been lowered for those who have diabetes and those who suffer from cardiovascular risk factors. This has been lowered to less than 70, whereas it was at 100. Gabbay added, “For people with diabetes with established heart disease — for example, if a person has had a heart attack — the new goal for LDL is 55 or lower instead of 70.”
For these two cases, medications for lowering blood pressure and cholesterol is necessary in order to lower the numbers, stated Gabbay.
Screening for Sleep Issues of Those with T2D Is also Needed
“The updated standards recognize the importance of sleep: duration of sleep, because we know that too much or too little can negatively impact health; the quality of sleep; and also the timing of sleep. All of these things can impact blood glucose levels as well as obesity risk,” said Gabbay.
“We know that metabolism has a circadian (day/night) rhythm,” said McClain. Research shows that going against that rhythm could bring about diabetes. In fact, they saw that those who work the night shift suffer from higher rates of diabetes, he added.
“We also know interrupted sleep causes abnormalities in glucose handling and insulin production,” said McClain. This could be why those who suffer from sleep apnea may be diagnosed with abnormal glucose and insulin regulation. Elevations in stress hormones and decreased oxygen levels also add to the problem.
The guidelines say that screening for sleep issues is needed by providers so that they can give better advice on diabetes and sleep. “If there are sleep disturbances, it may be necessary to see a specialist,” said Gabbay.
Exercise Is Especially Important Diabetics
Exercise for diabetics isn’t extremely different from the rest, but it’s more important for them. According to Gabbat, exercise becomes even more important for them because it’s essential for weight management as well as heart health.
“Most studies show benefits both of low-intensity and high-intensity exercise, and of aerobic and resistance exercise, and in most studies, there is a dose-response relationship such that more is better,” said McClain.
They said that adults need to exercise for 150 minutes a week, which can be spread out in at least three sessions. They made this so that it can be achievable for all. McCain said, “But even modest increases in activity — taking a short stand-up-and-walk every 30 minutes from the computer, for example — are beneficial.”
Social Determinants become a Major Factor in Diabetes Risk
People have easy access to the tools and strategies that lower the risk of diabetes. They also can get the proper medications and care for it. The first process to correct and identifying at-risk patients is to screen for food and housing insecurity and financial barriers. This is what ADA said.
“If you do not have access to healthcare or the means to pay for it, you are likely not going to be able to afford the best medications or preventive care that might be provided,” said McClain.
Also, lifestyle factors play a big part as well. “Do you live in a ‘food desert’ where the most accessible food is not necessarily the healthiest food? Do you live in a neighborhood where it is safe to go for a walk, and if not, can you afford membership to a facility where you can go to exercise? And the stress associated with living in an unsafe neighborhood can, in and of itself, contribute to abnormal glucose regulation,” said McClain.
There is a Need to Ask Your Doctor for the Updated Diabetes Standards of Care
The new standards of diabetic and heart care elaborates on the changes that are linked to technology, kidney disease prevention, and preventing amputations. The complete revised document can be found in the January 2023 issue of Diabetes Care.
It’s important that those who have diabetes talk to their doctors or a healthcare professional. They should ask about the new standards and ask crucial questions, said Gabbay.
“This could be a helpful prompt to a busy provider. Ask, ‘Is my blood pressure at goal? Are my cholesterol values where they need to be based on these new guidelines?’ Essentially, advocate for themselves and their health,” he advised.
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