Updated recommendations from ADA
The American Diabetes Association’s (ADA’s) Standards of Medical Care in Diabetes is updated and published annually in a supplement to the January issue of Diabetes Care. Based on new data, ADA changed the criteria for the diagnosis of diabetes to include two abnormal test results from the same sample (i.e., fasting plasma glucose and A1C from same sample). Additional conditions were identified that may affect A1C test accuracy including the postpartum period.
The ADA’s Professional Practice Committee, which includes physicians, diabetes educators, registered dietitians, and public health experts, develops the Standards. The Standards include the most current evidence-based recommendations for diagnosing and treating adults and children with all forms of diabetes.
Look up Standards of Medical Care in Diabetes—2019, American Diabetes Association, at http://clinical.diabetesjournals.org/content/37/1/11?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Clin_Diabetes_TrendMD_0
‘Midlevel’ providers not so ‘midlevel’
Patients with diabetes who received care from nurse practitioners and physician assistants working within the U.S. Veterans Affairs health system had outcomes equivalent to those of patients cared for by physicians in a primary care setting, according to a study published in the Nov. 20 issue of the Annals of Internal Medicine. Data was analyzed from 568 VA primary care centers, involving more than 350,000 adults with pharmaceutically treated diabetes.
The upshot? By using a team approach, healthcare providers are fully capable of providing high-quality care to patients with chronic disease.
“Given the right system – with resources to provide education and support, along with referral to an endocrinologist or a diabetes team if needed, and including more innovative programs, such as telehealth, online programs, and device-based data transfer and support – persons with diabetes can achieve their goals,” writes Anne L. Peters, M.D., Keck School of Medicine of the University of Southern California, in an editorial. “Moreover, it is time to stop calling NPs and PAs ‘midlevel’ providers, as is common in certain systems. Nurse practitioners and PAs are competent PCPs in their own right and should be fully accepted as such.”
Racial, ethnic disparities
Based on nationally representative data from 2015 and 2016, the Agency for Healthcare Research and Quality in December published a “Statistical Brief” regarding treatment and monitoring of adults with diabetes age 18 and over. The report offers estimates of the prevalence of reported diagnoses by race/ethnicity, and then focuses on differences among racial/ethnic groups in treatment and monitoring of the condition. Here are a few findings.
- An average of 10 percent (about 24.8 million people) were ever told by a health professional they had diabetes. Overall, blacks (13 percent) were more likely to have been diagnosed with diabetes than Hispanics (10.3 percent), whites (9.4 percent), or Asians (8.9 percent).
- Obesity is highly associated with diabetes, and the likelihood of being obese varies by race/ethnicity. In 2015-16, on average, about one-third (31.6 percent) of U.S. civilian non-institutionalized adults age 18 and older were obese (i.e., their body mass index – BMI – was 30 or higher). Blacks (41.7 percent) were more likely to be obese than Hispanics (34.9 percent) and whites (30.7 percent), while Asians (8.4 percent) were much less likely to be obese than those in other racial/ethnic categories.
- Among obese adults, Hispanics (14.8 percent) were less likely than blacks (18.2 percent) or whites (17.4 percent) to be reported as having been told they are diabetic.
- Regardless of race/ethnicity, in 2015-16, only a small proportion (2.3 percent) of adults age 18 and older with diagnosed diabetes reported not having their condition currently treated with insulin injections, oral medication, and/or diet modification.
- The percentage of people with diabetes using insulin injections was much lower for Asians (15.2 percent) than for the other racial/ethnic groups (28.2 to 32.0 percent). Conversely, Asians were more likely to report having their condition treated by both diet modification and oral medication (but no insulin injections) (57.0 percent) than those in other racial/ethnic categories (45.1 to 48.7 percent).
Regarding diabetes-monitoring services:
- Blacks (82.8 percent) and Hispanics (81.5 percent) were less likely than whites (89.0 percent) to have had their blood cholesterol checked.
- Hispanics (62.2 percent) and Asians (61.4 percent) were less likely than whites (71.6 percent) and blacks (69.3 percent) to have had their feet checked.
- Hispanics (59.3 percent) and Asians (56.5 percent) were less likely than whites (67.1 percent) to have had an eye examination.
- While nearly three-fourths of adults with diabetes (72.1 percent) reported having had the A1C test, over one-fifth (22.3 percent) did not know if they had that test during the year.
- Whites (76.7 percent) were more likely than the other racial/ethnic groups (63.4-66.3 percent) to report having had the A1C test and were less likely to report not having had the test (3.7 versus 7.4 to 9.0 percent). Moreover, whites were less likely to report not knowing whether they had the test than the other race/ethnic groups (19.5 versus 25.5 to 29.2 percent).
The size of a blueberry
Researchers led by the Massachusetts of Technology have developed a drug capsule that could be used to deliver oral doses of insulin, potentially replacing the injections that people with type 1 diabetes give themselves every day, reported MIT in February.
About the size of a blueberry, the capsule contains a small needle made of compressed insulin, which is injected after the capsule reaches the stomach. In tests in animals, the researchers showed that they could deliver enough insulin to lower blood sugar to levels comparable to those produced by injections given through skin. They also demonstrated that the device can be adapted to deliver other protein drugs.
“We are really hopeful that this new type of capsule could someday help diabetic patients and perhaps anyone who requires therapies that can now only be given by injection or infusion,” said Robert Langer, the David H. Koch Institute Professor, a member of MIT’s Koch Institute for Integrative Cancer Research, and one of the senior authors of the study.
The research team also included scientists from the pharmaceutical company Novo Nordisk.
A heads-up on glucose events
A new app feature uses artificial technology to assess whether someone with diabetes has a low, medium, or high likelihood of experiencing a low-glucose event in the next one to four hours. The new feature – called IQcast™ – was developed by Medtronic plc and IBM Watson Health, and is part of Medtronic’s Sugar.IQ™ personal diabetes assistant app.
The Sugar.IQ app is available to users of the Medtronic’s continuous glucose monitoring system, the Guardian™. With predictive alerts up to 60 minutes before a low or high event and within one to four hours of a low event, Guardian Connect and the Sugar.IQ app have been shown to help people with diabetes achieve an extra 36 minutes per day in a healthy glucose range of 70-180 mg/dL, including 30 minutes less time in hyperglycemia and 6 less minutes in hypoglycemia.