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Lifestyle Management Uplifted in 2017 ADA Diabetes Care Standards

Mary Caffrey
The recommendation to limit long periods of sitting comes after multiple studies show how it affects blood glucose management. ADA also gives providers charts to help them understand the cost of different therapies.
Move every 30 minutes during prolonged periods of sitting. Give older adults balance and flexibility training. Pay more attention to sleep patterns, given their known effect on blood sugar levels.

These recommendations and others occupy an entire section of the 2017 Standards of Medical Care in Diabetes devoted to lifestyle management.1 Together with language on prevention and management of psychosocial stressors, the annual update from the American Diabetes Association (ADA) promotes a more holistic approach, to coordinate care for factors that contribute to the onset and progression of the disease.

ADA’s recommendations come as CMS is moving forward with payment models that fit this approach. CMS has taken the first steps toward paying for the National Diabetes Prevention Program in Medicare starting in January 2018. Starting next month, Medicare will allow billing for collaborative care, which puts behavioral health and primary care services under one roof, a model that been shown especially effective for treatment of persons with diabetes.

Cost of Care. The ADA also took a step to help providers navigate costs: the 2017 standards feature 2 tables that estimate average monthly costs for insulin and non-insulin therapies. Last month, the ADA publicly called on Congress to investigate the rising cost of insulin, which patients with type 1 disease (T1D) need to survive, and which might benefit more patients with type 2 disease (T2D) if priced affordably. The 2017 standards include a new treatment algorithm for managing T2D with insulin, if patients have been unable to achieve glycemic goals.

Key scientific news in the ADA Standards is the report, “Differentiation of Diabetes by Pathophysiology, Natural History, and Prognosis,” which was published in ADA’s journal, Diabetes.2 The report was produced at a symposium of the ADA, the JDRF, European Association for the Study of Diabetes, and the American Association of Endocrinologists. According to a statement from ADA, it focuses on beta cell dysfunction and disease staging for T1D and T2D, and seeks to better define the subtypes to achieve more personalized care.

“The expert consensus is that unifying characteristics of the vast majority of diabetes is hyperglycemia, resulting from β-cell destruction of dysfunction,” Robert E. Ratner, MD, FACP, FACE, chief scientific officer for ADA, said in the statement. “With a better understanding of how various factors affect the number and function of β-cells, we may be able to classify subtypes of the diseases, predict the rate of progression and identify where and how interventions can be targeted to prevent or delay disease progression and complications.”

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