As understanding of diabetes evolves, so does the American Diabetes Association^® (ADA) Standards of Care in Diabetes, which provides comprehensive, evidence-based guidelines for the prevention, diagnosis, and treatment of the disease. Notable topics that have been updated this year include sleep health recommendations, consideration of social determinants of health, and new hypertension diagnosis cut-offs.

A panel of six experts in diabetes care will provide a deeper look at these changes in the Sunday, June 25, symposium Updates in ADA’s Standards of Care in Diabetes—2023, which begins at 8:00 a.m. PT in Ballroom 20A-C of the San Diego Convention Center. This session also will be available via livestream for registered meeting participants.

Eric L. Johnson, MD, Professor at the University of North Dakota School of Medicine and Health Sciences, said that while many cornerstones of diabetes care remain in place, there are several updates that warrant discussion, including a new medication, tirzepatide, as well as medications that affect weight loss—a topic that also will receive new emphasis.

“We have medications now that promote weight loss and are also very potent for lowering A1C and blood glucose levels,” Dr. Johnson said. “So I think one of the messages in these updates is that it’s easier to be more aggressive without fear of hypoglycemia while also promoting weight loss.”

Dr. Johnson said new cardiovascular goals will be an important part of the discussion, as they are now more in line with other professional societies like the American Heart Association and the American College of Cardiology. There will also be updates in cardiovascular care in relation to diabetes, including blood pressure goals and cholesterol goals for adults. Technology updates, such as new language about the use of continuous glucose monitoring (CGM), will also be discussed.

“It’s so important to stay up to date on what technology looks like, particularly CGM,” Dr. Johnson said. “There’s more language on what ‘time in range’ means and how that can be individualized, just like A1Cs are individualized.”

Kenneth Cusi, MD, FACP, FACE, Professor of Medicine at University of Florida Health, will discuss a new approach to determining cirrhosis risk called fibrosis-4 index screening (FIB-4).

People with type 2 diabetes are at a much higher risk of cirrhosis and liver cancer from nonalcoholic steatohepatitis (NASH), a more serious progression of nonalcoholic fatty liver disease, he explained. Once this disease becomes advanced, the ability to prevent end-stage organ damage is limited.

“The mission of anybody involved in the care of someone with diabetes is to diagnose this at an early stage when there are some therapies that can prevent disease progression or even reverse it completely,” Dr. Cusi said.

FIB-4 is a readily available diagnostic tool and easy to calculate with current electronic medical records. It uses a formula that considers age, liver aminotransferases ALT and AST, and platelet count, he said. This test also is available online and can provide an early assessment of a patient’s risk for liver fibrosis. If appropriate, a specialist can do further tests and put patients on a path to treatment, including two medications that can not only lower glucose but reverse the state of inflammation and possibly slow the progression of fibrosis: pioglitazone and glucagon-like peptide-1 (GLP-1) receptor agonists.

“Presentation attendees will understand the clinical impact of NASH on cardiovascular disease and in the development of cirrhosis in people with type 2 diabetes, and they’re going to know how to apply a stepped diagnostic algorithm and when to refer to hepatology,” Dr. Cusi said.

Drs. Johnson and Cusi will be joined by ADA Vice President for Health Care Improvement Nuha Ali El Sayed, MD, MMSc, Instructor of Medicine, Harvard Medical School; Vanita R. Aroda, MD, Director of Diabetes Clinical Research, Brigham and Women’s Hospital, and Associate Professor of Medicine at Harvard Medical School; Dennis Bruemmer, MD, PhD, Cleveland Clinic; Grazia Aleppo, MD, Professor of Endocrinology, Northwestern University Feinberg School of Medicine; and Adham Abdel Mottalib, MD, Joslin Diabetes Center.