Obesity First of Seven Changes to Diabetes Care

FiguraThe American Diabetes Association is out with their new standards of care for 2023 and at the top of the list of seven major changes is a refined focus on obesity. Changes in medical care are subtle and slow. But when you look at how it has evolved over recent years, the shift in views about the relationship between obesity and diabetes is remarkable.

Barely a decade ago, that shift began to favor treating type 2 diabetes with drugs that would be at least weight neutral – or preferably make it possible for patients to shed some excess weight.

Now, at last, the focus has shifted to favor a complementary role for obesity medicines for helping to improve the health of persons with diabetes or the risk of developing it. This is good news.

So here is a brief synopsis of the seven top points of news in the ADA Standards of Care in Diabetes for 2023.

1. New Meds Can Help with Obesity

At the intersection of obesity and diabetes care, healthcare providers now have better tools for managing obesity. The new standards make explicit mention of the opportunity for better outcomes in obesity treatment with new medicines.

2.  The Importance of Sleep

There’s new attention to the importance of healthy sleep patterns. New guidance recommends screening for this and making appropriate referrals to sleep medicine and behavioral health professionals.

3. Social Determinants of Health

Honestly, on this point, the ADA is a little late to the game. But better late than never. The association is now voicing the need to take social factors into account in tailoring care to the needs and constraints that patients face. This is part of a larger effort to make their standards of care more patient centered. We expect that this will mark the start of more changes to come.

4. Hypertension

Five years ago, the definition of high blood pressure changed. Yesterday, the ADA caught up with that.

5. SGLT2 Inhibitors

The role of this class of diabetes meds has grown to be more important for patients with heart failure based on impressive data from outcome trials. A helpful side effect is that they can bring some modest weight loss, too.

6. Finerenone

Another dividend from big, expensive outcome studies is the recognition that finerenone can be very helpful for patients with diabetes and kidney disease. It is a relatively new drug, approved by FDA in 2021.

7. New Goals for Lowering Cholesterol

This is another case of catching up. Four years ago, new guidelines recommended that the target for LDL cholesterol be set to less than 70 mg/dL in patients with diabetes. ADA is now on board.

Click here for the new guidelines and here for further reporting on them.

Figura, painting by Lyubov Popova / WikiArt

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December 13, 2022