Diabetes Core Update: Standards of Care 2016 – Special Edition

Podcast: Diabetes Core Update
Host: American Diabetes Association
Date: January 18, 2016
Key Guests:

• Dr. Neil Skolnik
• Dr. John J. Russell
• Dr. Joseph A. Stankaitis (member of the Standards of Care committee)

Overview

This special edition episode focuses on the 2016 American Diabetes Association (ADA) Standards of Care, as published in the January 2016 issue of Diabetes Care. Drs. Skolnik and Russell interview Dr. Joseph A. Stankaitis, a member of the committee responsible for developing the guidelines, to discuss key highlights, updates, and clinical recommendations relevant for practicing clinicians.

“The Standards… essentially establish the ongoing standard for care for diabetes both nationally and worldwide.”
– Dr. John J. Russell [00:32]

Key Discussion Points & Insights

1. How the ADA Standards are Developed

[02:16]

• The Professional Practice Committee (PPC) comprises multidisciplinary experts (e.g., physicians, pharmacists, dietitians, epidemiologists).
• Adherence to Institute of Medicine standards; all members disclose conflicts of interest.
• ADA receives no industry funding for the Standards.
• Annual, evidence-based review of literature to update recommendations.
• Emphasis on consensus and clarification based on evidence strength, not just new data.

“The group meets several times during the course of the year and it tries to adhere to the Institute of Medicine standards for developing trustworthy clinical practice guidelines.”
– Dr. Joseph A. Stankaitis [02:16]

2. Diagnosis of Diabetes: Recommended Tests

[04:13]

• Three diagnostic tests: fasting plasma glucose (FPG), 2-hour plasma glucose (OGTT), and A1C.
  • FPG ≥ 126 mg/dL, 2-hour OGTT ≥ 200 mg/dL, or A1C ≥ 6.5% = diabetes.
  • Prediabetes: FPG 100–125 mg/dL, 2-hour OGTT 140–199 mg/dL, or A1C 5.7–6.4%.
  • FPG/OGTT require fasting; A1C does not, but may be affected by age, ethnicity, or certain medical conditions.
  • Abnormal results should be repeated for confirmation.

“An A1C's got several advantages… greater convenience, greater pre-analytical stability, and less day to day changes due to stress or illness.”
– Dr. Stankaitis [06:07]

3. Screening Recommendations

[07:08]

• Screen all adults of any age who are overweight (BMI≥25, or ≥23 for Asian Americans) with ≥1 risk factor.
• Begin screening all patients at age 45, repeat every 3 years if normal.
• In children/adolescents: screen if overweight/obese with ≥2 additional risk factors.

“We're seeing an awful lot of prediabetes and type 2 diabetes in younger populations…So…consider screening them.”
– Dr. Stankaitis [07:50]

4. Definition and Management of Prediabetes

[08:24]

• Prediabetes identifies patients at high risk but not yet meeting diabetes thresholds.
• Often associated with obesity, dyslipidemia, hypertension (metabolic syndrome).
• Lifestyle intervention (diet, activity, behavior): intensive programs can reduce progression to diabetes by ~60% at 3 years.
  • Target: lose ~7% body weight, ≥150 minutes/week moderate activity.

“If you go through that…you nearly hit a 60% reduction in the rate of diabetes onset after 3 years.”
– Dr. Stankaitis [09:47]

5. A1C Goals & Individualization

[10:16]

• General goal for many non-pregnant adults: A1C < 7%.
• More stringent goal (<6.5%) for selected patients: short duration, long life expectancy, no CVD, can achieve without hypoglycemia.
• Less stringent goal (<8%) for patients: severe hypoglycemia history, limited life expectancy, comorbidities, long-standing, hard-to-control diabetes.
• Individualize to patient context.

“The theme…is that one needs to individualize what one's goals are based upon the patient at hand.”
– Dr. Stankaitis [10:45]

6. Obesity Management in Type 2 Diabetes (New Section)

[12:36]

• Recognized importance of weight management in both preventing and treating type 2 diabetes.
• Modest, sustained weight loss improves glycemic control; reduces need for medications.
• Recommendations address diet, physical activity, behavioral therapy, pharmacotherapy, and bariatric surgery.
• Emphasizes tailoring to patient needs and context.

“Modest and sustained weight loss has been really shown to improve glycemic control and really can reduce the need…for glucose lowering medications.”
– Dr. Stankaitis [13:16]

7. Hypoglycemia: Recognition and Management

[14:54]

• Prevention is critical due to association with mortality (e.g., ACCORD, ADVANCE studies).
• High-risk groups: children with type 1, elderly.
• Strategies: individualized education, dietary intervention (e.g., bedtime snacks), medication adjustments, glucose monitoring.

“Hypoglycemia prevention is really a critical component for diabetes management.”
– Dr. Stankaitis [14:54]

8. Immunizations

[16:01]

• All CDC/ACIP-recommended vaccines, with focus on:
  • Pneumococcal vaccine for all ≥2 years, and both PPSV23 and PCV13 for those >65.
  • Hepatitis B vaccine for unvaccinated adults ≥19 years.

9. Cardiovascular Risk Management

• Blood Pressure [17:27]:
  • Treat to BP <140/90 mmHg.
  • Lower targets (<130/80) may be good for younger, albuminuric, or high-risk patients if achieved safely.
  • Avoid overly aggressive BP lowering, especially in elderly.

“You certainly don't want to be overly aggressive with senior citizens…you've probably done them harm that way.”
– Dr. Stankaitis [18:28]

• Lipid Management [18:52]:

  • Lifestyle modification: weight loss, reduced saturated/trans fat, increased omega-3s and fiber, smoking cessation.
  • High-intensity statin for those with ASCVD; moderate for at-risk ages 40–75.

• Antiplatelet Therapy [20:08]:

  • Aspirin for secondary prevention in all with prior CV event.
  • Consider for primary prevention in ≥50 years with at least one risk factor (high 10-year CV risk); avoid if high bleeding risk.

“You should consider aspirin therapy as a primary prevention strategy for those people…who are at an increased cardiovascular risk.”
– Dr. Stankaitis [20:27]

Notable Quotes & Memorable Moments

• On the standards process:
  “ADA does not use industry support for this endeavor.”
  – Dr. Stankaitis [02:45]

• On prediabetes and prevention:
  “It’s not an absolute guarantee that you’re going to get it, but the probability is huge.”
  – Dr. Stankaitis [08:40]

• On the importance of individualization:
  “That’s the theme that seems to now be running through the standards of care…”
  – Dr. Stankaitis [10:45]

Important Timestamps

• [00:32] – Introduction to the Standards of Care and committee process
• [04:13] – Diagnostic tests for diabetes
• [07:08] – Recommendations for diabetes screening
• [08:32] – Defining prediabetes and management
• [10:16] – Setting and individualizing A1C goals
• [12:36] – New section: Obesity management in type 2 diabetes
• [14:54] – Recognition and management of hypoglycemia
• [16:01] – Immunization recommendations
• [17:27] – Blood pressure targets
• [18:52] – Lipid management strategies
• [20:08] – Antiplatelet therapy guidelines

Conclusion

This special episode delivers a concise overview of the 2016 ADA Standards of Care, emphasizing practical, evidence-based changes that can be directly applied by clinicians. Themes of individualization, comprehensive lifestyle management, careful attention to complications and comorbidities, and the importance of multifactorial prevention strategies are strongly underscored.

“We talked about screening for diabetes, identification and management of prediabetes, individualizing A1C goals, obesity and type 2 diabetes, hypoglycemia, management of blood pressure, cholesterol, and decisions about the use of antiplatelet agents…”
– Dr. Neal Skolnik [22:02]

For detailed recommendations and further reading:
Download the full or abridged Standards at diabetesjournals.org