American Diabetes Association Releases Revised 2024 Management Guidelines
The American Diabetes Association (ADA) has made significant revisions to its 2024 diabetes management guidelines, incorporating the latest research, technology, and treatments aimed at enhancing the overall health and quality of life for patients with diabetes.
New Treatment Options
The updated guidelines now include recommendations for the use of teplizumab, a novel drug that has shown promise in slowing the progression of type 1 diabetes, as well as bempedoic acid, a new medication designed for patients who are intolerant to statins. Additionally, the guidelines highlight sotagliflozin, a next-generation treatment for dyslipidemia that is administered twice a year.
In a significant shift, the ADA is now recommending early initiation of continuous glucose monitoring (CGM) after the diagnosis of type 1 diabetes.
Publication and Content
The revised guidelines are set to be published in the January issue of the ADA’s journal, Diabetes Care, and will cover a wide range of topics including the diagnosis and classification of diabetes, co-morbidity assessment, health promotion, and glycemic management.
Impact on Type 1 Diabetes
The ADA has emphasized the importance of monitoring individuals at risk of developing type 1 diabetes, citing factors such as age at seroconversion and the presence of diabetes-related autoantibodies as indicators of an increased risk.
Advancements in Treatment
Among the key updates are recommendations related to teplizumab, which has been shown to delay the onset of type 1 diabetes. The ADA also underscored the role of diabetes self-management and education, incorporating telemedicine and digital interventions into the guidelines.
Prevention and Treatment Considerations
The revised guidelines also address the prevention and treatment of hypoglycemia and obesity, offering new insights into the use of CGM and insulin delivery systems for effective management.
Cardiovascular Disease and Risk Management
In a major development, the guidelines now include the use of bempedoic acid, a drug proven to reduce LDL-cholesterol levels and lower the risk of cardiovascular events. Additionally, the guidelines cover new cholesterol-lowering treatments such as inclisiran, a twice-yearly injection, and sotagliflozin, a recently approved SGLT-1/2 inhibitor.
The ADA has updated its recommendations to include new FDA-approved treatments, reflecting the latest advancements in managing diabetes and related conditions.
The American Diabetes Association (ADA) has revised its 2024 diabetes management guidelines to largely reflect research, technology, and treatments that can improve the health and quality of life of diabetic patients.
Including teplizumab, a new drug that slows the progression of type 1 diabetes, bempedoic acid, a new drug for statin-intolerant patients, and sotagliflozin, a new SGLT-1/2 inhibitor, a next-generation treatment for dyslipidemia administered twice a year In addition to glyciran reflection, a recommendation was added that continuous glucose monitoring (CGM) should be started early after diagnosis of type 1 diabetes.
The ADA plans to publish the 2024 revised version of its diabetes management guidelines with this content in the January issue of the society’s journal Diabetes Care (doi: https://doi.org/10.2337/dc24-SINT).
Diagnosis and classification of diabetes, comprehensive assessment of co-morbidity, promotion of health and wellness behaviour, glycemic goals and hypoglycemia, diabetes techniques, weight management for the prevention and treatment of type 2 diabetes, and pharmacological approaches to glycemic management. The revised edition reflects many of the major new drug and diabetes management technologies that have recently emerged.
First, the section on preventing or delaying diabetes and related co-morbidities added recommendations to identify the importance of monitoring individuals at risk of developing type 1 diabetes.
Age at seroconversion (especially under 3 years), the number of diabetes-related autoantibodies identified, and the development of autoantibodies against islet cell antigen (IA-2) are all associated with faster progression to diabetes type 1. That is.
Revised management guidelines of the American Diabetes Association 2024. Suggested use of CGM from the time type 1 diabetes is diagnosed (level of evidence A).
They then added recommendations related to teplizumab, which slows the progression of type 1 diabetes, which was approved by the US FDA last year.
The association said, “Teplizumab has been found to delay the onset of type 1 diabetes in people aged 8 years or older as a result of clinical trials carried out on relatives of people with type 1 diabetes,” and added, “Teplizumab is given to those have symptoms.” “It can be considered in people over 8 years of age with type 1 stage 2 diabetes to delay the onset of type 1 diabetes (stage 3).”
Diabetes self-management and education (DSMES) items were also reviewed. Five periods were suggested as times to evaluate the need for DSMES: at diagnosis, when treatment goals are not met, when complicating factors occur, and when life and treatment transitions occur, and telemedicine and digital interventions were included in DSMES.
In the Evaluation, Prevention and Treatment of Hypoglycemia section, the recommendation has been revised to add content that emphasizes the benefits of using CGM to prevent hypoglycemia and provides guidelines for treating hypoglycemia using an automated insulin delivery (AID) system.
The association said, “CGM is particularly useful for diabetic patients at risk of hypoglycemia, so the use of CGM is increasing not only in type 1 diabetic patients but also in type 2 diabetic patients taking insulin, ” and added, “TIR (Time- in time) when assessing blood sugar through CGM. “in range) is associated with the risk of microvascular complications and can be used as an indicator to evaluate blood sugar status.”
The association then recommended the early application of CGM, insulin pumps, and AID systems to patients with type 1 diabetes from the time of diagnosis.
Obesity and weight management for the prevention and treatment of type 2 diabetes is the preferred pharmacotherapy for the management of obesity in patients with diabetes, including glucagon-like peptide 1 (GLP-1) receptor agonists or dual insulin-stimulating polypeptides ( GIP) and GLP-1 1 It was changed to include receptor agonists, and these dual GLP-1 and GIP were also introduced as options for better blood sugar control than insulin.
In the category of cardiovascular disease and risk management in diabetic patients, a new drug, bempedoic acid, has been added for those for whom statin therapy is not effective.
Bempedoic acid, whose phase 3 results were revealed by the American College of Cardiology in March this year, reduced LDL-cholesterol levels by 29.2 mg/dL compared to placebo in 13,970 patients who could not take statins because of side effects or did not respond. It has been proven to reduce cardiovascular events by 13% and cardiovascular disease deaths by 15%.
Next, inclisiran, a new next-generation short-intermittent ribonucleic acid (siRNA)-based drug, was included along with a PCSK9 inhibitor as a cholesterol-lowering treatment. Inclisiran is a twice-yearly injection method, eliminating the inconvenience of current treatments that typically require daily oral administration.
This was also reflected as sotagliflozin, an SGLT-1/2 inhibitor, received new FDA approval in the SGLT inhibitor class this year.
The association revised its recommendation to recommend SGLT-2 inhibitors or SGLT-1/2 inhibitors for patients with diabetes and heart failure with preserved ejection fraction or less to reduce the risk of worsening heart failure and cardiovascular death. A discussion of cardiovascular clinical trial results of the SGLT-1/2 inhibitor sotagliflozin was also added.
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