Ask Dr. Bob - Diabetes Standards of Care

Introduction

• Hosted by Dr. Bob Gab, Chief Scientific and Medical Officer at American Diabetes Association.
• Year 4 of the "Ask Dr. Bob" series focusing on diabetes.
• Current theme: Standards of Care in Diabetes, recently published by the American Diabetes Association.

Standards of Care

• Annual publication serving as a comprehensive guideline for healthcare professionals on diabetes care.
• Involves a review of the latest scientific research and recommendations by the Professional Practice Committee.
• Accessible through an app, used by healthcare professionals globally.

Coverage

• Includes all types of diabetes: Type 1, Type 2, gestational diabetes.
• Addresses care for different age groups: pediatrics, young adults, general population, older adults.

Key Updates

Cardiovascular Disease

• Leading cause of death for people with diabetes.
• Screening for Heart Failure:
  • New blood tests (BNP, proBNP) for early detection of heart failure risk.
  • Recommended for those with diabetes and cardiovascular risk factors.
• Peripheral Arterial Disease:
  • New screening recommendation using Ankle Brachial Index (ABI).
  • Suggested for individuals over 50 with diabetes complications, or diabetes for more than 10 years.

Obesity

• Medications:
  • First-line medications are Semaglutide (OIC, Wovi) and Tepati (M Jarro).
• Measurements:
  • Besides BMI, consider waist-to-hip ratio or waist size as obesity measures.

Type 1 Diabetes Updates

• Misdiagnosis Prevention:
  • Recommendations to distinguish between Type 1 and Type 2 diabetes in adults.
• Staging of Type 1 Diabetes:
  • Stage 1: Normal glucose, presence of predictive antibodies.
  • Stage 2: Abnormal glucose levels, not yet diabetic, presence of antibodies.
  • Stage 3: Elevated glucose levels, diagnosable diabetes.
• Stage 2 Treatment:
  • New medication (Tmb CED) can delay onset of Type 1 diabetes.

Other Complications

• Bone Health:
  • Increased fracture risk in diabetes patients.
  • Recommendation for Bone Mineral Density test for those 65+, or younger with osteoporosis risk factors.

Lifestyle Changes

• Religious Fasting:
  • Guidelines for managing diabetes during fasting.
• Fear of Hypoglycemia:
  • Health care professionals should screen for it.
• Sleep:
  • Promote good sleep; manage diabetes impact on sleep.

Technology in Diabetes Care

• Continuous Glucose Monitoring (CGM):
  • Essential for modern diabetes management.
  • Training programs available for healthcare professionals.
• AI for Retinal Photography:
  • FDA-approved AI can read retinal photographs for diabetic retinopathy.
• Early Technology Adoption:
  • Encourage early use of CGM and insulin pumps for newly diagnosed Type 1 diabetics.

Resources

• Full document and app available at the American Diabetes Association website.
• Future version tailored for laypeople in development.

Conclusion

• Follow Dr. Bob on social media for updates.
• Stay tuned for format changes in "Ask Dr. Bob" next year.
• Encouragement to share information with others who may benefit.

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• Note: These notes are intended as an overview and additional details can be found through the ADA's resources.