ADA Summary of New Revisions 2022

According to the American Diabetes Association (ADA) Professional Practice Committee, these are the 2022 revisions to standards of medical care in diabetes. 

Diabetes is a persistent disease requiring persistent clinical consideration with multifactorial risk reduction systems outside of glycemic control. Continuous diabetes self-management instruction and education are essential to stopping short-term complications and lessening the risk of long-term issues. A large amount of research exists that upholds interventions to increase positive diabetes results further. The American Diabetes Association (ADA) Standards of Care is used to provide practitioners, researchers, and policy influencers with general treatment goals to evaluate the quality of care. Although the Standards of Care are guides, they are not intended to come before clinical judgment. The guides serve as recommendations that include information on screening, diagnostics, and therapeutic actions that have a beneficial effect on health outcomes in those with diabetes. The ADA continuously updates the Standard of Care to ensure that those that use it can rely on it as the most complete authoritative source on diabetes care. 

The ADA has been developing and spreading clinical diabetes care recommendations for more than 30 years. To make changes to the Standards of Care, a special committee referred to as the Professional Practice Committee (PPC) performs extensive literature reviews on emerging clinical considerations. The PPC is a committee of experts that come from all different backgrounds, such as physicians, education specialists, and those who have specific expertise in an area such as epidemiology, public health, weight management, and diabetes prevention.  

Recommendations are supported evidence categorized as either level A, level B, or level C depending on the quality of research. There is also an expert opinion that it is defined as level E. Level E comes from recommendations with no clinical trials, or there is conflicting evidence. These new recommendations have been occurring annually since 1989. Below we will attempt to highlight some of the changes that have been added or changed entirely in the 2022 update.  

Section changes in the ADA diabetes guideline revisions 2022: 

Section one is improving care and promoting health in populations. Health numeracy and its role in diabetes prevention and management were added as well as content on community health workers.  

Section 2 is the classification and diagnosis of diabetes. This section recommended adequate carbohydrate intake before oral glucose tolerance testing. Additionally, information on immune checkpoint inhibitors being a cause of medication-induced diabetes was added. Gestational diabetes was revised in this section about the early pregnancy screening for diabetes and abnormal glucose metabolisms.  

Section 3 is the prevention or delay of type 2 diabetes and associated comorbidities. This is a new title for this section. Adults with obesity are recommended to begin an intensive lifestyle behavior change program. A new subsection was added titled “Pharmacologic Interventions.” In this subsection, more information was provided on the benefits of vitamin D supplementation. This section also targeted weight loss and halting progression of hyperglycemia. 

Section 4 is the comprehensive medical evaluation and assessment of comorbidities. New information was provided on the influenza vaccine and coronavirus disease vaccination based on new evidence.   

Section 5 is facilitating behavior change and well-being to improve health outcomes. More emphasis has been placed on the quality of carbohydrates selected. Additionally, a fiber goal has been added for clarity. 

Section 6 is glycemic targets. A subsection was added on glycemic assessment.  

Section 7 is diabetes technology. The term self-monitoring of blood glucose was replaced with blood glucose monitoring throughout the guidelines. Recommendations for continuous glucose monitoring were divided between adults and youth.  

Section 8 is obesity and weight management for the prevention and treatment of type two diabetes. More evidence has been provided on the importance of dealing with how obesity and diabetes increases the likelihood of severe COVID-19 infections. New medications for the treatment of obesity were updated to include semaglutide. 

Section 9 is pharmacologic approaches to glycemic treatment. A new recommendation has been made to include insulin and combination therapy with a GLP-1 receptor agonist. It has been shown to result in greater efficacy. 

Section 10 is cardiovascular disease and risk management. Ezetimibe, the preferred drug due to its low cost, has been removed. Additional discussion of the ADAPTABLE trial and the TWILIGHT trial has been added regarding aspirin therapy.  

Section 11 is chronic kidney disease and risk management. This section has been divided into two sections. The second section is section 12: retinopathy, neuropathy, and foot care. Recommendations have been made to include finerenone to slow CKD progression.  

Section 12 is retinopathy, neuropathy, and foot care. Intravitreous injections were added to the first-line treatment for macular edema. 

Section 13 is older adults. The upper limit of 8.5% was removed regarding those with multiple coexisting conditions. Those taking metformin long-term should monitor B12 deficiency. 

Section 14 is children and adolescents. This is a new section that focuses on the screening and treatment of complications related to type 1 diabetes in children. 

Section 15 is the management of diabetes in pregnancy. A new recommendation for telehealth visits and pregnant women with gestational diabetes was added. 

Section 16 is diabetes care in the hospital. CGM use during the COVID-19 pandemic decreases physical interaction between providers and patients. 

Section 17 is diabetes advocacy. No changes or updates were made to this section. 

Practice Pearls: 

• The American Diabetes Association Standards of Care is used to provide practitioners, researchers, and policy influencers with general treatment goals to evaluate the quality of care. 
• To make changes to the Standards of Care, a special committee referred to as the Professional Practice Committee (PPC) performs extensive literature reviews on emerging clinical considerations. 
• Recommendations are supported evidence categorized as either level A, level B, or level C depending on the quality of research. 

References for “American Diabetes Association (ADA) Summary of New Revisions 2022”:
“Summary of Revisions: Standards of Medical Care in Diabetes—2022.” Diabetes Care, vol. 45, no. Supplement_1, 2021, link 

 “Introduction: Standards of Medical Care in Diabetes—2022.” Diabetes Care, vol. 45, no. Supplement_1, 2021, link  

Kmeone Kingdom, MPH, PharmD Candidate, South College School of Pharmacy