Diabetes Pro Quarterly - Winter 2020 - 2

Professional News
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agonists in patients with or at high risk for CVD, kidney
disease, or heart failure, regardless of their current A1C or
A1C target
*	 New guidance on personalized A1C targets for children
and adolescents with diabetes, ranging from <6.5 to <8%
depending on factors such as frequency of glucose
monitoring and risk of hypoglycemia or hypoglycemia
unawareness
*	 Multiple approaches to insulin therapy, including the use of
less expensive human insulin options for people who may
be unable to afford newer analogs
The Standards of Care free mobile app (available from
professional.diabetes.org/socapp) has also been updated
and includes treatment algorithms converted to clinical tools
for use at the point of patient care. An abridged version of
the 2020 Standards of Care (available from professional.
diabetes.org/soc) geared to primary care providers is also
available, as well as a complete Standards of Care slide deck
and webcast with continuing education credit both available
from professional.diabetes.org/soc.
Updates to this year's Standards of Care include the following:

CVD in Diabetes
*	 The recommendations for treatment of CVD, the leading
cause of morbidity and mortality in individuals with diabetes,
have now been individualized based on patients' risks,
including the presence of atherosclerotic cardiovascular
disease (ASCVD) or ASCVD risk factors, diabetic kidney
disease, or heart failure (Section 10, page S122-123,
Recommendations 10.43A. 10.43B, and 10.43C).

*	 Use of SGLT2 inhibitors and GLP-1 receptor agonists in
patients with or at high risk for CVD, kidney disease, or
heart failure is now recommended regardless of patients'
current A1C or A1C target (Figure 9.1).

Pharmacologic Therapy Updates
*	 Figure 9.2 has been simplified to more easily guide
providers through intensification of injectable glucoselowering therapies (Section 9, page S104).
*	 Oral semaglutide, which was approved by the U.S. Food
and Drug Administration (FDA) in September 2019, is
now included in the discussion of combination therapies
(Section 9, page S105).
*	 Recommendation 11.3 was modified to provide more detail
on the use of SGLT2 inhibitors and GLP-1 receptor agonists
in patients with type 2 diabetes and diabetic kidney disease
(Section 11, page S135, Recommendation 11.3).
*	 In light of the FDA's approval of liraglutide in children ≥10
years of age, there is a new recommendation regarding
the pharmacologic management of type 2 diabetes in the
"Children and Adolescents" section (Section 13, page
S172, Recommendation 13.67).

Glycemic Targets
*	 Based on the 2019 publication "Clinical Targets for
Continuous Glucose Monitoring Data Interpretation:
Recommendations From the International Consensus
on Time in Range" (available from bit.ly/2S0g1bj), new
recommendations were added on the use of an ambulatory
glucose profile (AGP) report and time in range for
assessment of glycemic management (Section 8, page S68,
Recommendations 6.4 and 6.5). Additionally, an example of
an AGP report was added (Section 6, page S69, Figure 6.1).
*	 Table 6.1 has been updated to reflect a simplified estimated
average glucose table (Section 6, page S67), and intranasal
glucagon and glucagon solution for subcutaneous injection
have been added in the "Hypoglycemia" section in light of
the medications' recent FDA approval (Section 6, page S73).
*	 To provide more detail regarding individualizing targets,
new A1C goal recommendations for children were added
(Section 13, page S165, Recommendations 13.21-13.24).

Personalizing Patient Care
*	 As diabetes management improves, people with type 1
diabetes are living longer; thus, there is a newly added
subsection within the "Older Adults" section focusing on
special considerations for older adults with type 1 diabetes
(Section 12, page S158).
*	 The previously titled "Lifestyle Management" section was
changed to "Facilitating Behavior Change and Well-being
to Improve Health Outcomes," to better emphasize how
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Diabetes Pro Quarterly - Winter 2020

Table of Contents for the Digital Edition of Diabetes Pro Quarterly - Winter 2020
