American Diabetes Association Standards of Medical Care in Diabetes 2017

The American Diabetes Association’s (ADA) 2017 Standards of Care were published in Diabetes Care on 15 December 2016. Notable changes in the new guidelines include the recommendation of sodiumglucose cotransporter 2 (SGLT-2) inhibitor empagliflozin and glucagon-like peptide 1 (GLP-1) agonist liraglutide for type 2 diabetes (T2D) patients at high risk for cardiovascular morbidity and mortality. Data from the Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial and the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial are now included in the section on cardiovascular disease and risk management. In addition, fixed-ratio combinations of a basal insulin and a GLP-1 agonist are included in the algorithm for combination therapy, just weeks after the first of these products, Novo Nordisk’s (Copenhagen, Denmark) Xultophy (insulin degludec/liraglutide) and Sanofi’s (Paris, France) Soliqua (insulin glargine/lixisenatide), were approved by the US Food and Drug Administration (FDA) for prescription in the US. Based on recommendations from the International Hypoglycemia Study Group, the ADA’s 2017 Standards of Care features a new classification for hypoglycemia: clinically significant hypoglycemia is now defined at blood glucose levels <54 mg/dL, whereas blood glucose levels <70 mg/dL should be used as an “alert value” to help individuals avoid more severe hypoglycemia. The ADA’s new guidelines also include a greater emphasis on cost of diabetes drugs, T2D prevention (with a push for more frequent prediabetes screenings), and psychosocial support in diabetes care, especially for adolescents and pediatric patients.