New American Diabetes Association guidelines call for aggressive approach to weight loss, cholesterol and blood pressure

Diabetes management requires a more aggressive approach than previously advised, according to the latest recommendations from the American Diabetes Association. 

The organization’s 2023 Standards of Care guidelines, released Monday, include nearly 100 new or revised recommendations affecting all types of diabetes. The most notable updates include more stringent parameters for maintaining healthy weight, blood pressure and cholesterol levels – a reflection of new medications and technologies. They also place greater emphasis on reducing racial disparities in diabetes care.

People with diabetes now are advised to lose 15% of their body weight, up from the previous recommendation of 5%. This change was made to reflect increased access to more effective weight-loss medications. 

They also should strive for a blood pressure of less than 130 over 80, a target achievable with blood pressure medications, and lower cholesterol levels – recommendations that are in line with the American College of Cardiology. 

Diabetics with heart disease should seek an LDL cholesterol level of 70, down from the previous recommendation of 100. Those without heart disease should strive for an LDL level of 55, down from 70. Statins can help people achieve these marks. 

The Standards of Care are reviewed annually by the American Diabetes Association’s Professional Practice Committee. 

“Evidence-based recommendations drive better care for all people with diabetes, including vulnerable communities and those at high risk,” said Dr. Robert Gabbay, the ADA’s chief scientific and medical officer. “ADA’s Standards of Care are the gold standard for diabetes care and prevention that allows clinicians around the world to remain abreast of the rapidly changing healthcare landscape.”

The guidelines emphasize the importance of getting sufficient amounts of quality sleep. Too much or too little are linked to poorer diabetes outcomes. Doctors are urged to counsel their patients about proper sleep habits and to identify those with sleep issues.

Doctors also are advised to screen patients with diabetes for social needs such as food insecurity and a lack of access to fresh fruits and vegetables – factors that make it more difficult for people to properly manage diabetes. Doctors are urged to recommend high-tech treatments, such as automated insulin delivery devices and glucose pumps. 

Racial disparities in diabetes outcomes

People of color are more likely to be diagnosed with diabetes, according to the Centers for Disease Control and Prevention. The same is true of people of lower incomes and education levels. And these gaps have not significantly narrowed over the years, according to the CDC. 

Earlier this year, a Lancet study found evidence of racial or ethnic disparities in the initiation of newer diabetes medications, which may contribute to worse health outcomes.

Black people with diabetes are almost four times more likely to have a limb amputated than white people, and that disparity has grown worse over the years. To reduce this, improvements in foot ulcer and peripheral arterial disease screenings are necessary, according to the ADA’s new guidelines. Both conditions can lead to amputation. 

Because people of color are less likely to have the same access to advanced technologies, such as continuous glucose monitors and newer medications, as white people, the guidelines now emphasis the need for universal access. 

“This year’s annual report provides necessary guidance that considers the role health inequities play in the development of diabetes, particularly for vulnerable communities and communities of color disproportionately impacted by the disease,” said Chuck Henderson, the ADA’s chief executive officer. “This guidance will ensure health care teams, clinicians and researchers treat the whole person.”

Leon Rock, co-founder of the African American Diabetes Association, told USA Today that the ADA does not provide enough financial support to addresses these disparities or support diabetes researchers at historically Black colleges and universities.

Rock called the ADA’s new steps to address these issues “a start,” but he said “starting and doing is two different things.”