New ADA Guidelines: How Much Do You Know?

Test Your Knowledge of the Latest Advice on Diabetes Care

Sometimes it seems as if science and medicine change as often as the weather. One day, you read something’s good for you, and the next day, you hear too much of that “good thing” suddenly now is a “bad thing.” Unfortunately, diabetes is no exception to this trend. Change can be good, but sometimes updates can be confusing and hard to keep up with — especially when the experts don’t always agree.

In 2015, the American Diabetes Association (ADA) issued its Standards of Medical Care in Diabetes, an update of care guidelines issued annually. While they are intended for diabetes educators and health-care providers, the guidelines include important care information for everyone living with diabetes. What’s changed and what’s stayed the same? Find out by taking this quiz, and learn all you need to know about the new ADA guidelines. (You’ll find answers later in this article.)

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Q

1. Health-care providers are required to follow the ADA guidelines.
TRUE
FALSE

2. What is the purpose of the ADA guidelines?
I. To help medical researchers learn more about diabetes
II. To teach people who have diabetes about the condition
III. To ensure that all patients with diabetes receive the same treatment
IV. To provide information about best practices that are believed to provide the best possible outcome for a person who has diabetes

A. Any one of the above
B. Any two of the above
C. Any three of the above
D. None of the above
E. All of the above

3. Research has shown that a certain race or ethnicity is at greater risk for having diabetes at a lower body-mass index (BMI) than others. For which race or ethnic group was the BMI cutoff lowered?
A. White
B. Black
C. Latino/Hispanic
D. Asian
E. Pacific Islander or Native American

4. According to the new guidelines, all people — whether or not they have diabetes — should break up their sitting periods if they plan to sit for more than how many minutes?
A. 30 minutes
B. 50 minutes
C. 60 minutes
D. 90 minutes
E. 100 minutes

5. Which of the following is now considered the target range for your blood sugar before you eat?
A. 60–130 mg/dl
B. 70–130 mg/dl
C. 80–130 mg/dl
D. 90–130 mg/dl
E. 80–120 mg/dl

6. When it comes to measuring blood pressure, people who have both diabetes and high blood pressure should now aim for a diastolic blood pressure of
A. 75 mm Hg
B. 80 mm Hg
C. 85 mm Hg
D. 90 mm Hg

7. Which of the following is a risk factor for diabetes or prediabetes in adults who have no symptoms of the condition? More than one answer may apply.
I. Having a parent or sibling with the condition
II. Having macular degeneration
III. Being overweight
IV. Being of a certain race (Latino/Hispanic, Black/African American, Asian, Pacific Islander)
V. Having PCOS
VI. Having pelvic inflammatory disease
VII. Darkening of skin on the neck, armpits, buttocks, and nipples
VIII. Having low LDL
IX. Having heart disease

A. Any one of the above
B. Any three of the above
C. Any four of the above
D. Any six of the above
E. All of the above

8. What is the rating system for the recommendations on which the guidelines are based?
More than one answer may apply.
A. Expert opinions
B. Individual patient data
C. Clinical studies
D. Age
E. How long a patient has had diabetes

9. Based on the guidelines, which of the following might be the single most important factor your doctor, physician’s assistant, or nurse practitioner takes into account when determining how to best manage your diabetes?
A. Diseases you may already have
B. Age
C. Education
D. Your personal opinion and values
E. Your socioeconomic background

10. What is the new goal HbA1c for children and adolescents?
A. <5.5%
B. <6.0%
C. <6.5%
D. <7.0%
E. <7.5%

11. Which of the following could be reasons your doctor might refer you to another health-care professional if you have been diagnosed with diabetes or prediabetes? More than one answer may apply.
A. Concerns with vision or visual changes
B. Allergic reaction to medication
C. Mental health concerns
D. Desire to have a child
E. Chronic infections

12. Aside from diseases of the heart, kidneys, and eyes, which of the following are less-obvious health risks associated with diabetes? More than one answer may apply.
I. Osteoporosis and bone fractures
II. Alzheimer’s disease or other forms of dementia
III. Blood clotting problems
IV. Hearing problems

A. Any one of the above
B. Any two of the above
C. Any three of the above
D. None of the above
E. All of the above

13. Which of the following is a new section added to the guidelines?
A. Treatment or management of diabetes
B. Cardiovascular disease and risk management
C. Diabetes in older adults
D. Management of diabetes in pregnancy
E. Diabetes in children and adolescents

14. True or false? According to the new guidelines, health-care providers should also take into account the patient’s financial status when determining course of treatment.
TRUE
FALSE

15. The recommendations for foot care were updated to
A. Ensure that people who have problems with their feet have their feet checked at every doctor’s visit.
B. Ensure that all people who have diabetes have their feet checked at every visit.
C. Ensure that all people who have diabetes have their feet checked at least once a year.
D. Ensure that all people who have diabetes have their feet checked every six months.

A

1. FALSE. Every patient is different, and doctors and other medical professionals have to make decisions in the best interest of each individual patient. Recognizing these facts, the authors stress that the guidelines “are not intended to preclude clinical judgment and must be applied in the context of excellent clinical care, with adjustments for individual preferences, comorbidities, and other patient factors.” In other words, while the guidelines provide guidance based on the appropriate treatment for the majority of patients, they recognize the needs of each patient may be different and encourage each health-care team to provide individualized care.

2. C. Three of the above (I, II, and IV). The ADA guidelines are a compilation of recommendations. Numerous medical professionals and researchers compiled their studies and knowledge to establish best practices based on recent research. The purpose is to provide all interested parties — including scientists, doctors, nurses, pharmacists, researchers, insurance providers (payors), and patients — with the elements of diabetes care, general treatment goals, and tools to evaluate quality of care. While it primarily is a reference for medical professionals, it can be used by anyone with an active interest in diabetes.

3. D. According to the guidelines, the most recent data indicate that people who are of Asian American descent run greater risk of becoming diabetic than people of other races at lower BMI of 23 kg/m2. This is 2 kg/m2 lower than the cutoff of BMI of 25 kg/m2 for people of other races and ethnicities.

4. D. The Standards of Care encourage people to split their periods of sitting down into small intervals — especially if they are sitting for more than 90 minutes at a time. If you know you’ll be sitting for a long time, getting up to move around — even five minutes of movement can help improve circulation and focus. Studies show a sedentary lifestyle increases risk for building fatty tissue around your midsection, which has been shown to increase your risk for heart disease. According to the Mayo Clinic, people who either are not physically active or don’t get enough physical activity are more likely to have high triglycerides and abnormalities in insulin function.

5. C. The new target range for blood sugar before meals is 80 mg/dl–130 mg/dl. The previous ADA guidelines had a larger range (70 mg/dl–130 mg/dl). The range was updated after more recent studies showed the 80 mg/dl–130 mg/dl range better aligns with the HbA1c marker and might be beneficial for certain people — including those who have had diabetes for a long time, are prone to hypoglycemia, are of advanced age or frail, and/or may have advanced atherosclerosis. But the guidelines’ authors recognize that target ranges can vary from person to person. Your doctor may determine that you need a different range based on other factors including other health conditions, your age, and your personal needs.

6. D. According to the new guidelines, the goal diastolic reading for people are both diabetic and hypertensive is now 90 mm Hg instead of 80 mm Hg.

7. D. The ADA guidelines recommend anyone who has a parent, sibling, or child with diabetes get tested. It also urges anyone who is overweight (with a body mass index of 25kg/m2 or greater or 23 kg/m2 or greater for Asian Americans) be tested — especially if you are age 45 or older. Other risks include being of African American, Latino, Native American, Asian American, or Pacific Islander descent and being a woman with polycystic ovarian syndrome (PCOS), developing diabetes and/or high blood pressure during pregnancy and giving birth to a baby weighing over nine pounds.

Known as acanthosis nigricans, darkening of the skin on the neck, underarms, and buttocks, usually is also a sign of insulin resistance. While there is no mention of LDL in the guidelines, the ADA recommends people with very low HDL levels (35 mg/dl) and/or triglyceride level (250 mg/dl) get tested. If you are 45 or older and overweight and your tests come back normal, you still should be tested for diabetes at least every three years, depending on if you already have prediabetes or are at increased risk.

8. A and C. The guidelines have a rating system consisting of four categories: A, B, C, and E (there is no D rating for the guidelines.) Ratings of A, B, and C all are based on clinical trials, with A-rated recommendations having the strongest evidence supported by well-designed trials. Recommendations rated E are based on opinions of professionals considered to be experts in diabetes. Also, the guidelines say while B and C ratings are lower due to lack of evidence, that does not mean recommendations with these ratings are any less important.

9. D. Your personal values. While your age, education, and other health conditions undoubtedly all play a role in helping determine your course of treatment, the guidelines repeatedly encourage medical professionals to make their patients’ personal desires their top priority.

10. E. Based on new research, the guidelines recommend a new goal HbA1c of children and adolescents of <7.5%. Still, the ADA stresses the importance of customizing management of diabetes to the individual patient, even for those who have not yet reached adulthood.

11. A, C, and D. If you have diabetes, you probably already see a specialist to check your vision or visit a dietitian to help plan your meals. However, your doctor may guide you to a specialist if you are a woman of childbearing age who has diabetes and wants to have children. Sometimes, diabetes can affect your mood and ability to think clearly, and your doctor also may connect with you someone who specializes in mental health. Your doctor may want you to see a dentist, since diabetes can affect oral health.

12. C. Practically every cell in your body uses insulin, and consequently, having diabetes can affect many different organs and tissues throughout the body. In addition to heart, kidney, and eye conditions of which you already may be aware, diabetes also increases the risk of bone breaks because of osteoporosis. The guidelines say people with Type 1 diabetes are more prone to developing osteoporosis, while people with Type 2 diabetes are more likely to break their hips. Diabetes also can affect hearing, and some studies have shown patients are more likely to suffer from diseases affecting cognition such as vascular dementia and Alzheimer’s disease. It also has been found to affect testosterone levels in men.

13. D. The guidelines now include a section about pregnancy that addresses management of diabetes in women who already have Type 1 or Type 2 diabetes, as well as women who develop diabetes during pregnancy, known as gestational diabetes. This section offers recommendations for pre-pregnancy counseling, medications, goals for blood glucose, and monitoring. The chapter on treating diabetes has been updated to include the new drug class SGLT2 inhibitors, such as canagliflozin (brand name Invokana). Metformin remains the first line pharmacological treatment for patients able to take it.

14. TRUE. While a patient’s finances and insurance coverage undoubtedly can affect his or her ability to pay for certain medications and take more expensive medications regularly, the guidelines seek to lessen the impact of financial burden on the patient. The document outlines three objectives established by the National Diabetes Education Program (NDEP), one of which seeks to remove financial barriers and decrease patients’ out-of-pocket costs for diabetes education, eye exams, self-monitoring, and medications. The guidelines also encourage health-care providers to play a variety of roles that engage the patient and improve outcomes.

15. A. The guidelines strongly recommend “all patients with [feet that lack feeling], foot deformities, or a history of foot ulcers have their feet examined at every visit.” Patients also should perform self-checks on their feet between visits. To date, no medication has been shown to provide 100% relief of foot pain related to diabetes, according to the ADA, so the earlier a foot abnormality is detected, the better.