The American Diabetes Association (ADA) has made three important updatesto its 2019 Standards of Medical Care in Diabetes pertaining to cardiovascular and kidney disease.

1. Starting in 2018, the ADA began making real-time revisions to its online Standards document based on new developments, such as newly published studies or product approvals, rather than waiting until the end of each year to update recommendations.

This so-called "Living Standards of Care" is  available online immediately in Diabetes Care

2. "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 ADA said in a statement announcing the March 27 updates.  

3. Section 10, on cardiovascular disease and risk management, was revised to include a recommendation based on the outcomes from the Reduction of Cardiovascular Events with Icosapent Ethyl Intervention Trial (REDUCE-IT) advising that icosapent ethyl be considered to reduce cardiovascular risk in patients with diabetes and atherosclerotic cardiovascular disease, or other cardiac risk factors, who are taking a statin and have controlled low-density lipoprotein cholesterol (LDL-C) but elevated triglycerides.

4. That section — as well as in section 9, on pharmacologic approaches to glycemia treatment, and section 11, on microvascular complications and foot care — also includes several revisions based on the Dapagliflozin Effect on Cardiovascular Events - Thrombosis in Myocardial Infarction 58 (DECLARE-TIMI 58) trial, in which the sodium-glucose cotransporter type 2 (SGLT2) inhibitor dapagliflozin (Farxiga, AstraZeneca) reduced hospitalization for heart failureand progression in chronic kidney disease (CKD).

6. And also regarding dapagliflozin use in section 11, a revision reflects the recentlabel change to include approved use in CKD down to an eGRR ≥ 45 mL/min/1.73 m(previously ≥ 60 mL/min/1.73 m2).

Under this new process, the online version of the Standards and downloadable PDF are updated and revised throughout the year with highlighted annotations added to the text.

For each "living" Standards update, ADA notifies readers through emails, websites, and social media. Other materials including the Standards of Care slide deck, app, and professional education programs are also revised for consistency.   

ADA. Standards of Medical Care. Diabetes Care. 2019;42(Suppl 1)




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