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Tuesday, January 17, 2023

2023 diabetes guidelines


The recently announced 2023 American Diabetes Association Standards of Medical Care span nearly 300 pages and are fairly detailed. And considering the close connection between obesity and diabetes, weight loss is a key issue. What other changes have been important for the about 37 million Americans who have diabetes today?

Collaboration is essential for a lifestyle change.
There are no significant changes in this update, according to Dr. David M. Nathan, a professor at Harvard Medical School who co-authored and chaired past versions of these recommendations, which have been published annually for more than three decades. The majority of the typical lifestyle recommendations for treating diabetes are common sense: eat your vegetables, go outside and exercise, and get enough sleep.

Dr. Nathan, who oversees the Diabetes Center and the Clinical Research Center at Massachusetts General Hospital, notes a subtle shift in the counsel of the American Diabetes Association over the past five to ten years: an effort to make care for patients with diabetes more patient-centered. "This requires working with your doctor to develop a lifestyle and pharmaceutical plan that works for you," he explains. "Doctors do not instruct patients at the dinner table or bedside." They can assist you in making plans and decisions to effectively manage your diabetes, but you must be proactive.

Five lessons for diabetes maintenance
According to Dr. Nathan, people with type 2 diabetes, the most common form of the disease, should be aware of the five main takeaways from the guidelines:(Several of these guidelines also apply to people with type 1 diabetes, though they should consult their own doctors for specific recommendations.)

Strive for sound, consistent sleep. Experts have long acknowledged a connection between inadequate sleep and weight. Accumulating research suggests that sleep disturbances are also linked to diabetes risk. Dr. Nathan states that alterations in sleep habits can affect blood sugar regulation. Frequent reasons for disturbed sleep include obstructive sleep apnea, a dangerous disorder that involves recurrent, brief pauses in breathing throughout the night. Because it is more prevalent in adults with diabetes (especially those with obesity), anyone exhibiting the classic signs—loud snoring, snorts and gasps during sleep, and daytime tiredness despite a full night's rest—should be investigated. Ask your physician about a home sleep apnea test.



Don't "diet." Numerous trendy diets, including keto, paleo, intermittent fasting, and others, can aid in weight loss. However, the majority of people regain any weight lost once they stop following the program. According to Dr. Nathan, it is much more efficient to gradually adopt a healthy food pattern that you can maintain over time. The Mediterranean diet and the closely related DASH diet are viable options. It is especially crucial for those with diabetes to avoid sodas and other sugary drinks. In addition to eating fewer desserts, sweets, and fatty foods, you should consume more high-fiber carbohydrates, such as whole-wheat bread and brown rice.

Workout safely. Walking is a good form of exercise for the majority of people, provided they begin slowly and gradually increase their distance and speed. People with diabetes must pay special attention to selecting shoes that fit properly and periodically inspect their feet for redness, blisters, and ulcers. Because diabetes can induce neuropathy (numbness due to nerve loss), you may be unable to feel small injuries and trauma to your toes and feet. These conditions can lead to more severe foot issues and amputations.

Strive to achieve a healthier weight. The three strategies listed above can aid in weight loss; however, many obese individuals require medicine to shed considerable amounts of weight. Metformin, the most often prescribed blood sugar-lowering medication, may help people lose approximately five pounds on average. And while this little weight loss helps with diabetes and its complications, greater weight loss is more advantageous.

Semaglutide (Ozempic) and tirzepatide (Mounjaro), two relatively new diabetes medications, can help people lose up to 15 and 20 pounds, respectively. Additionally, they reduce hemoglobin A1c levels by up to two percentage points. (A1c is a three-month average blood sugar measurement.)

"These once-weekly injection medications are very promising and should be considered as an alternative to metformin for diabetics and obese people," says Dr. Nathan. In addition, they are prohibitively expensive (about $1,000 per month before insurance) and must be taken permanently, so they are not an option for everyone. The monthly cost of metformin is only $4.

Know your treatment's objectives. As in the past, the majority of diabetics should target an A1c level of 7% or below. Even if you don't lose weight, achieving this objective minimizes your risk for diabetes complications such as vision and kidney problems and neuropathy, according to Dr. Nathan.

Diabetes also increases the risk of cardiovascular disease. The desired blood pressure is below 130/80 mm Hg. At least a 50% reduction in LDL cholesterol (or achieving 70 mg/dL or lower) is desired. If you already have cardiovascular disease, the recommended LDL level is 55 mg/dL. Dr. Nathan explains, "Many of the patients I treat use cholesterol-lowering statins, and I frequently raise their dosages to assist them in attaining their goal." In rare cases, a combination of cholesterol-lowering drugs can help reduce stubbornly high LDL levels.

Havard Health
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