hello everyone and welcome to ask Dr Bob this is where you ask me Dr Bob gab the chief scientific and medical officer here at the American Diabetes Association your questions about diabetes and uh for those of you that have been watching this uh this is our fourth year already hard to believe and we'll be doing some new things this year which I'll tell you about later but let one of the things we we do is we we pick a theme uh and and because we just published the standards of care and diabetes uh that's going to be our theme and so let me let me start with a question is what are the standards of care so um the American Diabetes Association every year publishes uh this exhaustive um it's almost like a textbook of diabetes they their guidelines for healthc Care Professionals about what is the latest and greatest science and what does that mean in terms of recommendations for care and diabetes and so um it it is a big process just to give you an Insight under the hood of what it takes to do this so we each year we look at all of the papers published in diabetes the year before and and match them against all of the recommendations that we have and then bring all of that information to this incredible group called The Professional practice committee this is a group of interprofessional Health Care um brilliant people from various different parts of the diabetes world so yes endocrinologists adult Pediatrics but kidney Specialists heart specialists uh diabetes Educators dieticians uh uh psychologists really little thing uh and they scour through this and they discuss and they uh uh eventually argue at times on the recommendations until they come to a consensus and that's what we publish uh and these are really the the the globally recognized guidelines for Diabetes Care they're accessed over two million times uh by Health Care Professionals there's an app you might see your health care professional looking on their phone at the app and looking something up and making sure that they're giving you the best care possible and and so let's talk about what's in it um and and how this is important for you to know and so the the first the next question is does the standards of care you know cover updates for all types of diabetes and yes it does so for type 1 diabetes type two diabetes diabetes during pregnancy uh really the whole gamut and for uh younger people and the Pediatric age for young adults uh for the the general population and also for older adults there are sections about all of these different groups so really covers everything um it's it's quite an amazing document um so uh the big question is what are the key updates and you know again I said this is like a 300 page document so there's a lot of new stuff but I'm going to try to hit uh you know some of some of the big headlines like what's new this year and and and I think there two that I'm going to start with and and that's around cardiovascular disease and obesity so what's new in cardiovascular disease you know this is so important because if if you think about it you know the number one cause of death for people living with diabetes is cardiovascular disease and so that is something that is super important that we uh uh do the best we can to reduce the the risk of cardiovascular disease in people with diabetes so two things that I'm going to tell you in cardiov cardiovascular disease that are brand new and one is screening for heart failure so turns out that there are uh blood tests uh BNP or probnp or the name of the blood test and they can they can tell if somebody uh even without symptoms is at risk for heart failure uh and therefore what things need to be done uh to prevent that from happening so if you are uh a person with diabetes uh and have risk factors for heart failure high blood pressure cholesterol other cardiovascular disease um ask your healthc care professional if this blood test the BNP is something that um they that they should order for you because that's part of the recommendations so so I said there are two things in cardiovascular disease what is the second uh it's about something called Peripheral arterial disease so this is where the arteries uh typically in the legs uh can get clogged uh and that can lead to symptoms like claudication pain with walking that is relieved with rest and and we know that this is a cause for amputations and amputations unlike most complications of diabetes that have been getting better the number of amputations are rising and so it's very important that we identify people with Peripheral arterial disease and so with that as background what are the new recommendations and that is if you are over 50 years old and you have some other complication of diabetes you should be considered for screening for peral arterial disease and what's that screening test um it's called an anchal brachial index ABI anchal brachial index and what is that it's simply measuring blood pressure at the ankle and at the arm and comparing them and and that's a test that your healthc care professional can or order so if you're over 50 and you have risk factors uh smoking high blood pressure cholesterol those types of things um then you should ask your healthc care professional if uh an ABI an anial braal index is something that they should get for you so that's the that's one of the recommendations and the other is if you've had diabetes for over 10 years it might be worth getting that that test also so bring this to your health care professional this is The Cutting Edge you now know what they are uh uh just being exposed to because this just got released so what's new in the standards of care uh uh I said two big areas one cardiovascular disease and the other is obesity well there's been so much happening in the world of obesity in the last year and uh you know we we know that lifestyle continues to be important and we emphasize some strategies around lifestyle and we may do a separate uh session of ask Dr Bob to get into that uh more deeply the other recommendation is that when it comes to medications for obesity uh there are two firstline medicines before really the the two most recommended medicines and that is semaglutide and tepati you may know them by number of different brand names uh uh uh OIC or wovi is brand names for Sim glutide uh and for tepati um we have uh uh m jarro as the recom as as the brand name so those are the firstline drugs if you if if someone is going to be treated with medications um the other recommendation about obesity uh is that body mass index which is a calculation based on your your height and your weight uh and it gives you a number a BMI number you may have sometimes seen it as that and that's what we use to define whether someone is considered overweight or having obesity um and the recommendations this year are to say that's a great thing to calculate but you should also consider some other measurements uh a waist to hip ratio the the the the diameter of your waist versus your hip or just your waist what your waist size is can be another important measure of obesity and so that's the recommendation there so two big uh uh headlines out of the standards of care cardiovascular disease and obesity uh so the next question is well how about type 1 diabetes what's new there and I I think there there are a couple of things I want to share uh actually three things so let's do it uh first there are some recommendations because many times and this may have happened to you people with type 1 diabetes particularly as adults are misdiagnosed and thought to have type two because type two diabetes is more common well um we give some recommendations for healthc Care Professionals how to sort out whether someone has type one or type two so that they don't get uh misdiagnosed so that's that's recommendation one recommendation two is about the staging um so turns out that there are stages of type 1 diabetes what are those stages stes well stage one is when you uh have normal blood glucose uh but you have these special antibodies that are predictive of developing diabetes uh and and so if you have those antibodies but your blood glucose is normal you're in stage one stage two is when you have those antibodies two of those antibodies and your glucose levels are not normal but they're not high enough to say you have diabetes so that's that intermediate Zone stage two I'm going to talk about stage two in a moment because that's important to call that out and then stage three is is what we think of as type one diabetes your blood glucoses are elevated you're high enough to have uh be diagnosed with Frank type 1 diabetes and um and and that's what we serve always been talking about as type one diabetes so stage one stage two stage three so why is it important well for stage two diabetes we now have a treatment that if we find that people have stage two diabetes meaning that they have antibodies and their glucoses are abnormal but not enough to say they have diabetes there's a new medication uh called tmab CED is the brand name and it's been shown and approved by the FDA to delay the development of type 1 diabetes and so you might have antibodies someone may have the antibodies but not have Frank type 1 diabetes and this can Forstall the development of type 1 diabetes and their need for insulin so those are the recommendations around type one diabetes as I said the standards of care are just chalk full of information and lots of recommendations so uh there there are a couple of other that I want to throw out and this this is a question you know what what are what about other complications or issues of diabetes there's something new on that and there is and and this is what I want you to be aware of and and that's about bone health so here's something most people don't know that people would type one diabetes have uh a a fourfold increase risk of fractures fourfold they're are much higher risk of uh having fractures hip fractures being the the sort of most common and people with type two diabetes are also at higher risk about about 50% higher risk of fractures so because of that increase risk of fractures the recommendation is if you're 65 or older you should get a a test called a bone mineral density a dexa test um and that's something that your healthc care professional can uh order for you again if you're over 65 you should bring that to their attention uh that ask them if you should have a bone mineral density test um and sometimes if you're less than 65 but you have other risk factors for osteoporosis uh like a family member with it uh it may be also appropriate for you to have that test done so bone health is is sort of the the the new issue to be thinking about along with sort of the things that we typically think about in terms of uh preventing complications so the next question was what about lifestyle changes and anything new there and and yeah I want to I want to talk about three things the first is is there's a there's a whole section on on how to manage religious fasting uh there are a number of cases where fasting is is a part of someone's religion and we want to help them do that safely and they're guidelines specifically on how to do that uh the second is that we want uh Health Care Professionals to screen uh people with diabetes for their fear of hypoglycemia uh and ask questions about that because that can help influence the what is the best treatment for them and and then the last thing is there's some recommendations about promoting good sleep because we know that either too little or too much sleep um Can worsen diabetes and therefore it's important to help people um identify if they have sleep problems and also what are the Sleep routines that can help them get good sleep so more to come on that but that's uh that's an important issue if you are having issues with sleep you should talk to your Healthcare professional about it okay let me round out the last thing and this is always a subject that people are interested in and the question here is in this year's standards of care anything addressing technology well uh yes absolutely uh we can't be talking about diabetes without thinking about technology these days um and so first it's um we're really recommending that Health Care Professionals should also be all be very comfortable um and proficient in working with diabetes technology specifically continuous glucose monitor that's something that is here to stay it's an important part of diabetes management and we want to make sure that Health Care Professionals are uh um understanding of how to use that information that comes from a continuous glucose Mon and we have train training programs to help them uh become proficient um the the second is that you know we hear about uh um AI a lot artificial intelligence so it turns out that uh when you get a a retinal photograph a photograph of the back of your eye which can be done by Health Care Professionals in different settings uh they can now be read uh effectively uh by Ai and are actually some FDA approved artificial intelligence readings of these retinal photographs and so you may be getting those so it's good to know um and then the the last thing I'll say about technology is really recommending now technology use early in the course of diabetes so someone newly diagnosed with type 1 diabetes don't need to wait before we offer a continuous glucose monitor or insulin pump or automated insulin delivery think about that early on and so if you're newly diagnosed with type 1 diabetes um uh you should ask about whether some of these Technologies are right for you so I covered a lot of ground today in the standards of care uh uh please spread the word if this is helpful and you know other people that this information would be useful for and the question always comes up where can I find out more well the entire standards of care uh as well as an app uh as well as a u uh a webinar on it is all available free to your healthc Care Professionals and feel free to suggest it to them but you may want to look at it I I I'll just tell you it's not written uh for uh uh sort of lay people it's has a lot of technical language so uh sorry about that we are working on a version that would be specific specific to people living with diabetes so stay tuned to that but all of that's available uh uh at no charge at the American Diabetes Association website so look for the standards of care there and so with that uh thank you for listening stay tuned for our next episode uh next month uh please spread the word if this has been helpful um follow me on LinkedIn on on Facebook because I post lots of other things that can be helpful for you to live healthy with your diabetes and stay tuned for the changes uh in 2024 to the format of ask Dr Bob so be well and take care