New diabetes guidelines
The experts at the American Association of Clinical Endocrinologists (AACE) have released 2022 diabetes guidelines that have a couple of key updates from the last version (released in 2015). Here are the ones that I find the most interesting:
Weight management is stressed as a key way to prevent diabetes. This is very important as we now have more safe and more effective medications to help with weight loss than ever before. And we will likely have more available in the next few years. Hopefully, more drug benefits plans will soon cover them so that we can prevent diseases like diabetes.
Several of the newer diabetes medications in the DPP-4, SGLT-2 and GLP-1 classes are recommended earlier in the disease as they protect the heart and kidneys and do not lead to weight gain like some of the older agents. In the case of SGLT-2 inhibitors and GLP-1 receptor agonists, they actually lead to weight loss!
Pre-diabetes is defined as a hemoglobin A1C (HbA1C) of 5.7-6.4 which is in line with the American Diabetes Association. In Canada, pre-diabetes is defined as a HbA1C of 6.0-6.4 by the Canadian Diabetes Association. Treating pre-diabetes earlier and more aggressively with lifestyle modifications and weight loss medications will help more people to avoid diabetes.
One additional change I would have liked to see is in the recommendations for the treatment of diabetic neuropathy (painful nerve damage in the feet often seen with diabetes). AACE lists pregabalin, duloxetine and capsaicin 8% patch as effective medications for pain control. I wish they had also included topiramate as I have found it to be effective for many patients with a beneficial side effect of mild to moderate weight loss. It is found in the weight loss medication Qysmia in the US which unfortunately is not available in Canada.
Overall AACE has made 170 updated evidence-based clinical practice recommendations. For the purposes of this post, I chose to focus on the recommendations on weight management in pre-diabetes and diabetes. If you are interested in the many other changes, you can read the full guidelines here.