DC 23 Srev
DC 23 Srev
DC 23 Srev
SUMMARY OF REVISIONS
GENERAL CHANGES SECTION CHANGES Recommendation 2.1b was added to the
The field of diabetes care is rapidly chang- Section 1. Improving Care and “A1C” subsection to address the utility of
ing as new research, technology, and Promoting Health in Populations point-of-care A1C testing for diabetes
treatments that can improve the health (https://doi.org/10.2337/dc23-S001) screening and diagnosis.
and well-being of people with diabetes Recommendation 1.7 was added to
address the use of community health Section 3. Prevention or Delay of Type 2
continue to emerge. With annual updates workers to support the management of Diabetes and Associated Comorbidities
since 1989, the American Diabetes Associ- diabetes and cardiovascular risk factors, (https://doi.org/10.2337/dc23-S003)
ation (ADA) has long been a leader in pro- especially in underserved communities Recommendation 3.9 was added to ad-
ducing guidelines that capture the most and health care systems. dress statin use and the risk of type 2 dia-
current state of the field. Additional language and definitions betes, including the recommendation to
The 2023 Standards of Care includes regarding digital health, telehealth, and monitor glucose status regularly and en-
revisions to incorporate person-first and telemedicine were added, along with
force diabetes prevention approaches
inclusive language. Efforts were made the benefits of these modalities of care
in individuals at high risk of developing
delivery, including social determinants of
to consistently apply terminology that type 2 diabetes who were prescribed
health in the telehealth subsection.
empowers people with diabetes and statin therapy.
The subsection “Access to Care and
recognizes the individual at the center Recommendation 3.10 was added to
Quality Improvement” was revised to add
of diabetes care. language regarding value-based payments address the use of pioglitazone for reduc-
Although levels of evidence for several to listed quality improvement efforts. ing the risk of stroke or myocardial infarc-
recommendations have been updated, The “Migrant and Seasonal Agricultural tion in people with history of stroke and
these changes are not outlined below Workers” subsection was updated to include evidence of insulin resistance and
where the clinical recommendation has more recent data for this population. prediabetes.
remained the same. That is, changes in More defining terms were added for Recommendation 3.12 was added to
evidence level from, for example, E to C non-English speakers and diabetes educa- communicate that pharmacotherapy (e.g.,
are not noted below. The 2023 Standards tion in the “Language Barriers” subsection. weight management, minimizing the pro-
of Care contains, in addition to many minor gression of hyperglycemia, cardiovascular
changes that clarify recommendations or Section 2. Classification and risk reduction) may be considered to sup-
reflect new evidence, more substantive Diagnosis of Diabetes port person-centered care goals for people
revisions detailed below. (https://doi.org/10.2337/dc23-S002) at high risk of developing diabetes.
Recommendation 3.13 was added to Section 5. Facilitating Positive Health ning, treatment, and referrals when indi-
state that more intensive preventive ap- Behaviors and Well-being to Improve cated, and to include caregivers and
proaches should be considered for individ- Health Outcomes family members of people with dia-
uals who are at particularly high risk of (https://doi.org/10.2337/dc23-S005) betes. Details were added about re-
progression to diabetes. The title has been changed from “Facili-
sources for developing psychosocial
tating Behavior Change and Well-being
screening protocols and about inter-
Section 4. Comprehensive Medical to Improve Health Outcomes” to be in-
vention. Across the specific psychoso-
Evaluation and Assessment of clusive of strength-based language.
cial domains (e.g., diabetes distress,
Comorbidities Recommendation 5.8 was added to the
“Diabetes Self-Management Education anxiety), details were added about
(https://doi.org/10.2337/dc23-S004)
and Support” subsection to address data supporting intervention and care
In Recommendation 4.3, language was
social determinants of health in guid- approaches to support psychosocial and
modified to include evaluation for overall
ing design and delivery of diabetes behavioral outcomes in people with dia-
health status and setting of initial goals.
use with automated insulin delivery and/or chronic kidney disease, the treat- atherosclerotic cardiovascular disease risk
systems. ment plan should include agents that re- factors, to reduce the LDL cholesterol by
Literature and information was added duce cardiorenal risk. $50% of baseline and to target an LDL
on benefits on glycemic outcomes of Recommendation 9.4c was added to cholesterol goal of <70 mg/dL.
early initiation of real-time CGM in chil- address the consideration of pharmaco- Recommendation 10.21 was added to
dren and adults and the need to con- logic approaches that provide the effi- consider adding treatment with ezetimibe
tinue CGM use to maximize benefits. cacy to achieve treatment goals. or a PCSK9 inhibitor to maximum toler-
The paragraph on connected pens Recommendation 9.4d was added to ated statin therapy in these individuals.
was updated to include smart pen caps. address weight management as an im- Recommendations 10.22 and 10.23
References were updated for auto- pactful component of glucose-lowering were added to recommend continuing
mated insulin delivery systems to include management in type 2 diabetes. statin therapy in adults with diabetes
all the approved systems in the U.S. in Information was added to address aged >75 years currently receiving statin
2022. considerations for a GLP-1 receptor ago- therapy and to recommend that it
Section 11. Chronic Kidney Disease Recommendation 12.20 was revised to Injections and Continuous Glucose Moni-
and Risk Management reflect that gabapentinoids, serotonin- toring in Diabetes) trial.
(https://doi.org/10.2337/dc23-S011) norepinephrine reuptake inhibitors, tricy- A new Recommendation 13.7 was
The recommendation order was rear- clic antidepressants, and sodium channel added: for older adults with type 1 diabe-
ranged to reflect the appropriate order blockers are recommended as initial phar- tes, consider the use of automated insulin
for clinical interventions aimed at pre- macologic treatments for neuropathic delivery systems (evidence grade B) and
venting and slowing progression of pain in diabetes and that health care pro- other advanced insulin delivery devices
chronic kidney disease. fessionals should refer to a neurologist or such as connected pens (evidence grade
In Recommendation 11.5a, the levels pain specialist when pain control is not E) should be considered to reduce risk of
at which a sodium–glucose cotransporter achieved within the scope of practice of hypoglycemia, based on individual ability.
2 inhibitor could be initiated were the treating physician. The addition of this recommendation
changed. The new levels for initiation are New information was added in the was based on the results of two small
an estimated glomerular filtration rate “Neuropathy” subsection, under “Treat- randomized controlled trials (RCTs) in
for more consistency in the Standards of different methodologies and different use of computerized prescriber order en-
Care. outcomes. Both RCTs support stricter try (CPOE) to facilitate glycemic manage-
In Recommendation 14.110, “patients” blood pressure targets in pregnancy to ment as well as insulin dosing algorithms
was changed to “adolescents and young improve outcomes. This modification is using machine learning in the future to
adults” for clarity. based on new data from the Chronic inform these algorithms.
In Recommendation 14.111,“pediatric di- Hypertension and Pregnancy (CHAP) trial, In Recommendation 16.5, the need
abetes provider” was changed to “pediatric which included individuals with preexist- for individualization of targets was ex-
diabetes care teams” to reflect the team- ing diabetes. panded to include a target range of
based nature of diabetes care. The new Recommendation 15.27 sup- 100–180 mg/dL (5.6–10.0 mmol/L) for
In Recommendation 14.113, “patient” ports breastfeeding to reduce the risk of noncritically ill patients with “new” hy-
was changed to “young adult” for clarity. maternal type 2 diabetes. The benefit of perglycemia as well as patients with
breastfeeding should be considered when known diabetes prior to admission.
choosing whether to breastfeed or for-