Arlington, Virginia. April 16^th, 2019. The American Diabetes Association® (ADA) issued important updates to the 2019 Standards of Medical Care in Diabetes (Standards of Care), in annotations as the Living Standards of Care, focused on improving cardiovascular and renal health in people with diabetes. The updates were informed by newly published research and crafted and approved by the ADA’s Professional Practice Committee, which is responsible for producing the annual Standards of Care.

According to
a release of ADA, “Atherosclerotic cardiovascular disease (ASCVD) is the
leading cause of morbidity and mortality for individuals with diabetes, and
heart disease is the cause of one in four deaths in the U.S. Diabetes is the
leading cause of chronic kidney disease, and approximately one out of four
adults with diabetes has kidney disease. Recently published research indicated
an urgent need to update the 2019 Standards of Care to ensure optimal treatment
recommendations for people with cardiovascular disease and diabetes, and for
those with chronic kidney disease and diabetes.”

The March 27
Living Standards of Care updates are:

Section 10
was updated based on the outcome of Reduction of Cardiovascular Events with
Icosapent Ethyl–Intervention Trial (REDUCE-IT), which determined the addition
of icosapent ethyl to statin therapy for patients with high triglyceride levels
reduced cardiovascular events.

The
Standards of Care now include a recommendation that icosapent ethyl be
considered for patients with diabetes and atherosclerotic cardiovascular
disease (ASCVD) or other cardiac risk factors on a statin with controlled
LDL-C, but with elevated triglycerides (135-499) to reduce cardiovascular risk.

Sections 9,
10, and 11 have been revised based on findings from The Dapagliflozin Effect on
Cardiovascular Events-Thrombosis in Myocardial Infarction 58 (DECLARE-TIMI 58)
Trial, in which dapagliflozin treatment showed a reduction of hospitalization
for heart failure and a reduction in progression of chronic kidney disease
(CKD).

For
patients with diabetes and CKD, the approved use per estimated glomerular
filtration rate (eGFR) has been revised

Based on a
revision to the prescribing information for dapagliflozin, for patients with
diabetes and CKD, the approved use per estimated glomerular filtration rate
(eGFR) has been revised from ≥60 mL/min/1.73 m2 to ≥45 mL/min/1.73 m2 in
Section 11 of the Standards of Care.

“New
research can lead to improved patient outcomes and quality of life, and the American
Diabetes Association is proud to continue to provide the most current
evidence-based guidelines for people living with diabetes. These Living
Standards of Care updates via the online annotations to our yearly Standards of
Care enable us to translate and communicate significant research findings that
will empower health professionals to provide optimal care for millions of
Americans living with diabetes,” said the ADA’s Chief Scientific, Medical and
Mission Officer William T. Cefalu, MD.

The
Standards of Care provide the latest in comprehensive, evidence-based
recommendations for the diagnosis and treatment of children and adults with
type 1, type 2 or gestational diabetes; strategies to improve the
prevention or delay of type 2 diabetes; and therapeutic
approaches that reduce complications and positively affect health outcomes.
Beginning in 2018, the ADA updates and revises the online version of the
Standards of Care throughout the year, with annotations for new evidence or
regulatory changes that merit immediate incorporation. The online version of
the Standards of Care will include any research updates or policy changes that
are approved throughout 2019.

Updates to the Standards of Care are established and revised by the ADA’s Professional Practice Committee (PPC). The committee is a multidisciplinary team of 14 leading U.S. experts in the field of diabetes care and includes physicians, diabetes educators, registered dietitians and others whose experience includes adult and pediatric endocrinology, epidemiology, public health, lipid research, hypertension, preconception planning and pregnancy care. For the 2019 Standards of Care, two designated representatives from the American College of Cardiology (ACC) reviewed, provided feedback and endorsed the recommendations for cardiovascular disease and risk management on behalf of the ACC. The PPC performs an extensive, global clinical diabetes literature search each year for the annual Standards of Care update, supplemented with input from ADA leaders and staff and the medical community at-large. Members of the PPC must disclose potential conflicts of interest with industry and/or relevant organizations; these disclosures are available on page S184 of the 2019 Standards of Care.

About
Diabetes Care®

Diabetes Care, a monthly journal of the American Diabetes Association (ADA), is the highest-ranked, peer-reviewed journal in the field of diabetes treatment and prevention.

About the
American Diabetes Association

Approximately
every 21 seconds, someone in the United States is diagnosed with diabetes.
Nearly half of the American adult population has diabetes or prediabetes, and
more than 30 million adults and children are living with the disease.

The American Diabetes Association (ADA) is the United States’ leading voluntary health organization on a mission to prevent and cure diabetes, as well as improve the lives of all people affected by the disease.