Published October, 2022
The American Association of Clinical Endocrinology [AACE] Diabetes Mellitus Comprehensive Care Plan 2022 Update
The 2022 AACE Diabetes Clinical Practice Guideline Update was developed by an AACE task force led by Lawrence Blonde, MD, FACP, MACE, Director of the Ochsner Diabetes Clinical Research Unit. The task force evaluated an extensive pool of scientific literature to revise, update and/or create new recommendations based on important new evidence from antihyperglycemic efficacy studies, cardiovascular, diabetic kidney disease [DKD]/chronic kidney disease [CKD] and heart failure outcome trials of glucose lowering medications. Hypertension, dyslipidemia, and anti-obesity research as well as advances in technologies and techniques [including continuous glucose monitoring, insulin pump therapy and increasingly automated insulin delivery systems] were also used in updating and/or adding new recommendations that address therapeutic questions.
The Guideline was divided into four sections:
- Section 1 – Diabetes screening, diagnosis, glycemic targets, glycemic monitoring.
- Section 2 – Comorbidities [obesity, hypertension and dyslipidemia] and complications [retinopathy, neuropathy, DKD or CKD in diabetes, and cardiovascular disease].
- Section 3 – Management of prediabetes, type 2 diabetes, type 1 diabetes, diabetes in hospitalized persons and diabetes in pregnancy; focusing on selection of glycemic targets, lifestyle interventions and antihyperglycemic pharmacotherapy.
- Section 4 – Education and topics regarding diabetes and infertility, nutritional supplements, post transplantation and secondary diabetes, social determinants of health (SDOH), virtual care, depression, team approach, occupational risk, role of sleep medicine, and vaccinations in persons with DM.
The Guideline notes that for persons with T2D some newer antihyperglycemic medication classes can reduce glycemia with a low risk for hypoglycemia. Additionally, some classes offer weight loss and/or cardiorenal protection. As a result, the AACE Guideline recommends that individualized pharmacotherapy for persons with T2D should be prescribed based on evidence for benefit that includes in addition to glucose lowering, avoidance of hypoglycemia and weight gain, and reduction of cardiorenal risk. For example, one recommendation states “Independent of glycemic control, targets, or treatment, if there is established or high risk for atherosclerotic cardiovascular disease, heart failure, and/or CKD, clinicians should prescribe agents with proven efficacy for the specific condition(s) of the person with T2D being treated”
The AACE Guideline also emphasizes that a patient centered, multidisciplinary team, shared decision making approach helps people best manage diabetes. In addition to primary care clinicians and endocrinologists, the team may include certified diabetes care and education specialists (CDCES), nurses, dietitians, pharmacists, eye care clinicians, podiatrists, psychologists, and other specialists.
