Classification and Diagnosis of Diabetes, 3. Diabetes Care. We offer luxurious, affordable and best hotel accommodation nearest to the venue of the conference. For all other people, testing should begin at age 35 years. The Standards of Care is developed by the ADAs multidisciplinary Professional Practice Committee, which comprises expert diabetes health care professionals (HCPs). 7.12 rtCGM A or isCGM C should be offered for diabetes management in adults with diabetes on basal insulin who are capable of using the devices safely (either by themselves or with a caregiver). The choice of device should be made based on the individuals circumstances, preferences, and needs. Such programs should, at minimum, provide monthly contact and support, recommend ongoing monitoring of body weight (weekly or more frequently) and other self-monitoring strategies, and encourage regular physical activity (200300 minutes/week). 6.10 Occurrence and risk for hypoglycemia should be reviewed at every encounter and investigated as indicated. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes2023 Summary of Revisions: Standards of Care in Diabetes2023 International Tables of Glycemic Index and Glycemic Load Values: 2008 E. Diabetes confers significantly greater maternal and fetal risk largely related to the degree of hyperglycemia but also related to chronic complications and comorbidities of diabetes. A, 10.38 Aspirin therapy (75162 mg/day) may be considered as a primary prevention strategy in those with diabetes who are at increased CV risk, after a comprehensive discussion with the patient on the benefits versus the comparable increased risk of bleeding. C, 10.22 In adults with diabetes aged >75 years already on statin therapy, it is reasonable to continue statin treatment. "The American Diabetes Association (ADA) is the leading voice advocating for insulin affordability and is working to ensure that all people with diabetes have access to the care they need. Indication of overbasalization should prompt reevaluation to further individualize therapy. A, 9.4b In adults with type 2 diabetes and established/high risk of atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and/or chronic kidney disease (CKD), the treatment regimen should include agents that reduce cardiorenal risk. E, 8.5 Individuals with diabetes and overweight or obesity may benefit from modest or larger magnitudes of weight loss. Such specialized psychosocial care should use age-appropriate standardized and validated tools and treatment approaches. Prevention or Delay of Type 2 Diabetes and Associated Comorbidities, 4. Screening for prediabetes and type 2 diabetes risk through an informal assessment of risk factors or with an assessment tool, such as the ADAs Diabetes Risk Test (diabetes.org/socrisktest) is recommended and can inform who needs laboratory testing. . ACEi, ACE inhibitor; ACR, albumin-to-creatinine ratio; CVOT, cardiovascular outcomes trial; DPP-4i, dipeptidyl peptidase 4 inhibitor; GLP-1 RA, glucagon-like peptide 1 receptor agonist; HHF, hospitalization for heart failure; SGLT2i, sodium-glucose cotransporter 2 inhibitor; T2D, type 2 diabetes. A, 13.15 In older adults with type 2 diabetes at increased risk of hypoglycemia, medication classes with low risk of hypoglycemia are preferred. The importance of routine vaccinations for people with diabetes has been elevated by the coronavirus disease 2019 (COVID-19) pandemic. B, 11.5c In people with type 2 diabetes and DKD, consider use of SGLT2 inhibitors (if eGFR is 20 mL/min/1.73 m2), a GLP-1 receptor agonist, or a nonsteroidal MRA (if eGFR is 25 mL/min/1.73 m2) additionally for CV risk reduction. A, 4.4 A follow-up visit should include most components of the initial comprehensive medical evaluation (see Table 4.1 in the complete 2023 Standards of Care). Learn how these standards continue to evolve. This algorithm for the comprehensive management of persons with type 2 diabetes (T2D) was developed to provide clinicians with a practical guide that considers the whole patient, his or her spectrum of risks and complications, and evidence-based approaches to treatment. https://doi.org/10.2337/cd23-as01. A, 10.47 In people with type 2 diabetes with stable HF, metformin may be continued for glucose lowering if eGFR remains >30 mL/min/1.73 m2 but should be avoided in unstable or hospitalized individuals with HF. Upon completion of this activity, participants should be able to: Attendance at any Mayo Clinic course does not indicate or guarantee competence or proficiency in the skills, knowledge or performance of any care or procedure(s) which may be discussed or taught in this course. B, 12.29 The use of specialized therapeutic footwear is recommended for people with diabetes at high risk for ulceration, including those with loss of protective sensation, foot deformities, ulcers, callous formation, poor peripheral circulation, or history of amputation. B. 1.1 Ensure treatment decisions are timely, rely on evidence-based guidelines, include social community support, and are made collaboratively with patients based on individual preferences, prognoses, comorbidities, and informed financial considerations. ARLINGTON, Va., Dec. 12, 2022 /PRNewswire/ -- Today, the American Diabetes Association (ADA) published Standards of Care in Diabetes2023 (Standards of Care), comprehensive, evidence-based guidelines for the prevention, diagnosis The American Diabetes Association (ADA) is thrilled to announce the recipients of the 2023 National Scientific and Health Care Achievement Awards. A, 9.7 The early introduction of insulin should be considered if there is evidence of ongoing catabolism (weight loss), if symptoms of hyperglycemia are present, or when A1C levels (>10% [86 mmol/mol]) or blood glucose levels (300 mg/dL [16.7 mmol/L]) are very high. In the critical care setting, continuous intravenous insulin infusion is the most effective method for achieving glycemic targets. 15.17 Telehealth visits for pregnant people with GDM improve outcomes compared with standard in-person care. E, 14.64 Less stringent A1C goals (such as 7.5% [58 mmol/mol]) may be appropriate if there is an increased risk of hypoglycemia. Number of days CGM device is worn (recommend 14 days), 2. C. In hospitalized individuals with diabetes who are eating, point-of-care (POC) glucose monitoring should be performed before meals; in those not eating, glucose monitoring is advised every 46 hours. The patient characteristic categories are general concepts. 15.15 Insulin is the preferred medication for treating hyperglycemia in GDM. A, 10.36 Long-term treatment with dual antiplatelet therapy should be considered for individuals with prior coronary intervention, high ischemic risk, and low bleeding risk to prevent major adverse cardiovascular events (MACE). Reprinted from Agiostratidou G, Anhalt H, Ball D, etal. ARLINGTON, Va., March 14, 2023 /PRNewswire/ -- The American Diabetes Association (ADA) is thrilled to announce the recipients of the 2023 National Scientific and Health Care Achievement Awards . CGM systems that measure and display glucose levels continuously. A, 12.22 The examination should include inspection of the skin, assessment of foot deformities, neurological assessment (10-g monofilament testing with at least one other assessment: pinprick, temperature, vibration), and vascular assessment, including pulses in the legs and feet. Preventing avoidable infections not only directly prevents morbidity, but also reduces hospitalizations, which may additionally reduce the risk of acquiring infections such as COVID-19. To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, to improve overall health and: Attain individualized glycemic, blood pressure (BP), and lipid goals, To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful foods, willingness and ability to make behavioral changes, and existing barriers to change, To maintain the pleasure of eating by providing nonjudgmental messages about food choices while limiting food choices only when indicated by scientific evidence, To provide an individual with diabetes the practical tools for developing healthy eating patterns rather than focusing on individual macronutrients, micronutrients, or single foods. A, 10.41a In people with type 2 diabetes and established ASCVD, multiple ASCVD risk factors, or diabetic kidney disease (DKD), an SGLT2 inhibitor with demonstrated CV benefit is recommended to reduce the risk of MACE and/or HF hospitalization. B. Diabetes technology includes insulin delivery devices such as insulin pumps (also called continuous subcutaneous insulin infusion [CSII]) and connected insulin pens, glucose monitoring devices via CGM systems and glucose meters, automated insulin delivery (AID) systems that integrate CGM and insulin delivery with algorithms to modulate insulin delivery, and diabetes self-management support software. The American Diabetes Association (ADA) is taking the best of two worlds from the Advanced Postgraduate Course and the Clinical Conference to bring to you a fresh, new learning experience, outstanding speakers, and leading-edge educational content. Any use of this site constitutes your agreement to the Terms and Conditions of Online Registration. A, 10.41c In people with type 2 diabetes and established ASCVD or multiple risk factors for ASCVD, combined therapy with an SGLT2 inhibitor with demonstrated CV benefit and a GLP-1 receptor agonist with demonstrated CV benefit may be considered for additive reduction in the risk of adverse CV and kidney events. Simplification of the insulin plan to match an individuals self-management abilities has been shown to reduce hypoglycemia and disease-related distress without worsening glycemic outcomes. The recommendations, tables, and figures included here retain the same numbering used in the complete Standards of Care. B, 12.6 Programs that use retinal photography (with remote reading or use of a validated assessment tool) to improve access to DR screening can be appropriate screening strategies for DR. San Diego Convention Center, San Diego, USA. Join the fight with us on Facebook ( American Diabetes Association ), Spanish Facebook (. The safety and efficacy of noninsulin glucose-lowering therapies in the hospital setting is an area of active research. Courage. Diabetes Advocacy in the complete 2023 Standards of Care. The American Diabetes Association's 83rd Scientific Sessions (#ADA2023), meeting will take place June 23-26, 2023 at San Diego Convention Center, San Diego, USA. Accreditation StatementIn support of improving patient care, Mayo Clinic College of Medicine and Science is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team. Reassess benefits and risks of continuing treatment when eGFR falls to <45 mL/min/1.73 m2, and do not initiate metformin in patients with an eGFR already at this level. Glycemic variability (%CV) target 36%, 6. CVD AND RISK MANAGEMENT, for details on CV risk reduction recommendations). B, 13.1 Consider the assessment of medical, psychological, functional (self-management abilities), and social domains in older adults to provide a framework to determine targets and therapeutic approaches for diabetes management. Adapted from Davies MJ, Aroda VR, Collins BS, etal. TAR: % of readings and time >250 mg/dL (>13.9 mmol/L), 7. The program will start on Friday, June 23 at 11:30 a.m., and conclude on Monday, June 26 at 12:15 p.m. B, 6.6 On the basis of HCP judgment and patient preference, achievement of lower A1C levels than the goal of 7% may be acceptable and even beneficial if it can be achieved safely without significant hypoglycemia or other adverse effects of treatment. B, 6.12 Glucagon should be prescribed for all individuals at increased risk of level 2 or 3 hypoglycemia, so that it is available should it be needed. E, 6.3 Standardized, single-page glucose reports from CGM devices with visual cues, such as the ambulatory glucose profile (AGP), should be considered as a standard summary for all CGM devices. 5.28 Children and adolescents with type 1 diabetes C or type 2 diabetes or prediabetes B should engage in 60 minutes/day or more of moderate- or vigorous-intensity aerobic activity, with vigorous muscle-strengthening and bone-strengthening activities at least 3 days/week. through hard work and determination. C, 5.40 When indicated, refer to mental health professionals or other trained HCPs for further assessment and treatment for symptoms of diabetes distress, depression, suicidality, anxiety, treatment-related fear of hypoglycemia, disordered eating, and/or cognitive capacities. B. B, 10.27 For individuals who do not tolerate the intended intensity, the maximum tolerated statin dose should be used. The 2023 American Diabetes Association (ADA) Clinical Update Conference: February 10-12, 2023, was held in person at the Westin Tampa Waterside Hotel and virtually. Risk-Based Screening for Type 2 Diabetes or Prediabetes in Asymptomatic Children and Adolescents in a Clinical Setting. The American College of Cardiology/American Heart Association ASCVD risk calculator (Risk Estimator Plus) is generally a useful tool to estimate 10-year risk of a first ASCVD event (available online at tools.acc.org/ASCVD-Risk-Estimator-Plus). Improving Care and Promoting Health in Populations, 2. The Diabetes Management 2023 CNE conference is designed to provide an overview of diabetes management including updates to the 2023 ADA Standards of Care, implementing ADA recommendations and algorithms in clinical practice, advances in diabetes technology, patient education, nutrition, cardiovascular and mental health living with diabetes, and . E, 7.30 People with diabetes who are competent to safely use diabetes devices such as insulin pumps and CGM systems should be supported to continue using them in an inpatient setting or during outpatient procedures, once competency is established and proper supervision is available. Powered by the EthosCE Learning Management System, a continuing education LMS. More or less stringent glycemic goals may be appropriate for individual patients. A lower A1C goal may be set for an individual if achievable without recurrent or severe hypoglycemia or undue treatment burden. C, 7.5 Initiation of CGM, CSII, and/or AID early in the treatment of diabetes can be beneficial depending on a persons/caregivers needs and preferences. However, of those 100, there are six . C. 5.33 Evaluate baseline physical activity and sedentary time. vicinity of the conference center. A, Review previous treatment and risk factor management in people with established diabetes. The 13-member board is comprised of forward-thinking, innovative medical, scientific . Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goals. Reprinted from Davies MJ, Aroda VR, Collins BS, etal. More stringent A1C targets (such as <6.5% [48 mmol/mol]) may be appropriate for selected individuals if they can be achieved without significant hypoglycemia or other adverse effects of treatment. Tour de Cure is the premier fundraising campaign of the American Diabetes Association , now with virtual engagement designed for anyone and everyone to participate. American Diabetes Association; Standards of Care in Diabetes2023 Abridged for Primary Care Providers. Therefore, constant diligence and sometimes reevaluation is necessary. B. Glycemic control is assessed by the A1C measurement, continuous glucose monitoring (CGM) using time in range (TIR) and/or glucose management indicator (GMI), and blood glucose monitoring (BGM). MANAGEMENT OF DIABETES IN PREGNANCY for additional information. Children and adults with diabetes should receive vaccinations according to age-appropriate recommendations. A, 11.5a For people with type 2 diabetes and DKD, use of an SGLT2 inhibitor is recommended to reduce CKD progression and CV events in patients with an eGFR 20 mL/min/1.73 m2 and urinary albumin 200 mg/g creatinine. Adapted from Kirkman MS, Briscoe VJ, Clark N, etal. B, 12.27 Refer individuals who smoke and have a history of prior lower-extremity complications, loss of protective sensation, structural abnormalities, or PAD to foot care specialists for ongoing preventive care and lifelong surveillance. In general, specific risks of diabetes in pregnancy include spontaneous abortion, fetal anomalies, preeclampsia, fetal demise, macrosomia, neonatal hypoglycemia, hyperbilirubinemia, and neonatal respiratory distress syndrome, among others. The American Diabetes Association is the nation's leading 501(C)3 nonprofit charity providing diabetes research, information and advocacy. People with diabetes should be prioritized and offered SARS-CoV-2 vaccines. B, 12.28 Provide general preventive foot self-care education to all people with diabetes, including those with loss of protective sensation, on appropriate ways to examine their feet (palpation or visual inspection with an unbreakable mirror) for daily surveillance of early foot problems. The classification of diabetes type is not always straightforward at presentation, and misdiagnosis may occur. 3.6 Metformin therapy for the prevention of type 2 diabetes should be considered in adults at high risk of type 2 diabetes, as typified by the DPP, especially those aged 2559 years with BMI 35 kg/m2, higher fasting plasma glucose (FPG) (e.g., 110 mg/dL), and higher A1C (e.g., 6.0%), and in individuals with prior GDM. ADA Advises New BP, Lipid Targets for People With Diabetes Miriam E. Tucker December 13, 2022 New more aggressive targets for blood pressure and lipids are among the changes to the annual. C, 6.11 Glucose (approximately 1520 g) is the preferred treatment for the conscious individual with blood glucose <70 mg/dL (3.9 mmol/L), although any form of carbohydrate that contains glucose may be used. For individual hotel booking best resource is our website. Pharmacologic Approaches to Glycemic Treatment in the complete 2023 Standards of Care for detailed information on pharmacologic approaches to type 1 diabetes management. B, 7.9 Although BGM in individuals on noninsulin therapies has not consistently shown clinically significant reductions in A1C, it may be helpful when altering nutrition plan, physical activity, and/or medications (particularly medications that can cause hypoglycemia) in conjunction with a treatment adjustment program. 1Tsapas A, Avgerinos I, Karagiannis T, etal. The awards honor academics, health care . . B. Medications approved by the FDA for the treatment of obesity are summarized in Table 8.2 of the complete 2023 Standards of Care. Strategies to reduce readmissions include targeting ketosis-prone type 1 diabetes, treating individuals with admission A1C >9% (75 mmol/mol) with insulin, and implementing a transitional care model. In the setting of an individual whose diabetes is partially or wholly managed by someone else (e.g., a young child or a person with cognitive impairment or dexterity, psychosocial, and/or physical limitations), the caregivers skills and preferences are integral to the decision-making process. C. Essential to achieving diabetes treatment goals are DSMES, medical nutrition therapy (MNT), routine physical activity, tobacco cessation counseling when needed, health behavior counseling, and psychosocial care. In Diabetes2023 Abridged for Primary Care Providers and risk management, for details on CV reduction... 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