The ADA has made changes to the standards of medical care for diabetes » Medvestnik

The ADA has published updated standards of care for diabetes. The 2022 guidelines emphasize that atherosclerotic cardiovascular disease is the leading cause of death in patients with the disease. The leading risk factors are hypertension, dyslipidemia and chronic kidney disease.

To estimate the 10-year risk of developing cardiovascular disease in diabetes, it is recommended to use a special calculator developed by the American College of Cardiology (ACC) and the American Heart Association (AHA).

Patients with hypertension and a high risk of cardiovascular disease are treated with therapy aimed at maintaining blood pressure (BP) levels below 130/80 mmHg. If the risk of cardiovascular disease is low, it is recommended to maintain blood pressure levels below 140/90 mmHg.

Patients with moderate hypertension can begin treatment with a single drug. When the blood pressure level increases from 160/100 mm Hg. and above, it is recommended to take two antihypertensive drugs simultaneously. ACE inhibitors or angiotensin receptor blockers are recommended as first-line therapy for hypertension in patients with diabetes and coronary artery disease.

When triglyceride levels rise to 150 mg/dL or higher and HDL cholesterol falls below 40 mg/dL, patients are advised to make lifestyle changes that include weight loss, eating a Mediterranean diet, and increasing physical activity.

In patients 40-75 years old without atherosclerotic cardiovascular diseases, in addition to lifestyle changes, moderately intensive statin therapy is indicated. It is also recommended to start taking statins in patients aged 20–39 years with risk factors for atherosclerotic cardiovascular disease. High-intensity statin therapy is indicated for patients aged 50–70 years with a high risk of cardiovascular disease.

High-intensity statin therapy and lifestyle changes are indicated for patients of any age with diabetes and atherosclerotic cardiovascular disease. If the risk is extremely high and low-density lipoprotein cholesterol levels are 70 mg/dL or higher and persist during treatment, additional therapy (ezetimibe or PCSKA9 inhibitors) is indicated.

Patients with type 2 diabetes and diabetic kidney disease with an estimated glomerular filtration rate of 25 ml/min per 1.73 m2 and higher and a urine albumin concentration of 300 mg/g creatinine or more, the prescription of SGLT2 inhibitors is recommended.

Patients at risk of progression of chronic kidney disease or increased risk of developing cardiovascular disease, as well as those who cannot use SGLT2 inhibitors, are indicated for the administration of a non-steroidal mineralocorticoid receptor antagonist (finerenone).

MV previously published the updated ADA Standards of Care for Diabetes, presented in December 2021.

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