The American Diabetes Association (ADA) released its 2018 Standards of Medical Care in Diabetes this week, and several of the new recommendations involved older adults with co-morbidities, including those with cardiovascular disease or hypertension as well as diabetes.
Among the changes in the guidelines relevant to older adults:
- Based upon the results of multiple cardiovascular outcome trials (CVOT), there are new treatment recommendations for adults with type 2 diabetes, suggesting a pathway for people with heart disease that, after lifestyle management and metformin, should include a medication validated to improve heart health. A new table outlines the data from recent CVOT studies, and a new figure details our recommendations based on those CVOT studies.
- A new algorithm illustrating the recommended antihypertensive treatment approach for adults with diabetes and confirmed hypertension (blood pressure ≥140/90 mmHg) has been added.
- Also new this year is the recommendation that all hypertensive patients with diabetes monitor their blood pressure at home to help identify potential discrepancies between office vs. home blood pressure, and to improve medication-taking behavior.
- The immunization needs for people with diabetes were clarified and updated to more closely align with recommendations from the Centers for Disease Control and Prevention.
- A new section describes emerging evidence that speciﬁc glucose-lowADA releases 2018 diabetes care guidelinesering medications can delay the onset and progression of kidney disease.
In addition, three new recommendations targeting older adults were added to highlight the importance of individualizing pharmacologic therapy to reduce the risk of hypoglycemia, avoid overtreatment and simplify complex regimens while maintaining personalized blood glucose targets.
The 2018 Standards of Care are available online.