This transcript has been clearly edited.
Welcome to the second video of the American Diabetes Association Standards for Care in Diabetes – 2025.
Start with section 5. Promoting wellbeing to improve health behavior and health outcomes. ”
This section highlights the concept that people really need to mention for self-management education and support for diabetes. I couldn't agree any more. My patients always learn something when they go to these individual or group sessions. Send patients for diabetes education. Because it is very useful.
Then they go into these other recommendations, but I think that's important. I've seen a lot of people Glucagon– Peptide 1 (GLP-1) receptor agonist or dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonist therapy is getting too detailed. They really need to learn what a normal healthy weight is.
They now recommend screening malnutritionespecially for those who have undergone metabolic surgery or are being treated with weight-controlled pharmacological therapy. We think that if a patient starts to lose too much lean weight, it's causing real damage to the patient. Remember, you can get too thin.
They recommend the lifestyle I recommend. This means that it has plant-based proteins and fibers. At least encourage it in your diet, limiting and reducing foods containing saturated fat Cardiovascular risk.
They also recommend drinking water as the main source of liquid intake, not even sugar-like sodas or diet sodas. I am trying to encourage patients to drink water. Many of them are better than me, but it's important to discuss that.
What I really love is that they now discuss the difference between religious fasting and intermittent fasting. They worked together Diabetes and the International Ramadan Unionand they basically have new people who see the similarities and differences between religion and intermittent fasting.
Next, we discuss how to approach patients who are fasting of both types. I really like it, and I think it's very helpful as many of us have patients who fast both kinds of fasting, and knowing how to manage those patients It is important.
They talk about smoking bans, including cigarettes, e-cigarettes and cannabis. They say that I live in California and what's a bit funny to me is that I'm at risk of cannabis hyperemesis syndrome so I don't use recreational cannabis in any way.
I have a lot of patients who use legal recreational cannabis, but I have warned about cannabis syndrome syndrome. Most of them aren't trying to give up on cannabis use, so I just want to make sure they are safe when they use it.
From a psychosocial care perspective, they talk about screening for diabetes distress, depressionanxious, fear Hypoglycemiaand disturbed eating behavior. These are very important. They are very helpful in showing two new tables that are very helpful in explaining all psychosocial concerns, and the relationship between type 1 and diabetes-related outcomes in people of type 1. Type 2 diabetes.
Section 6 is titled ” Blood glucose goals and hypoglycemia. “Most of this section is a new subsection on the hyperglycemia crisis. This was published a few months ago, but I recommend checking it and making sure you know what you know well as we are reviewing it and discussing the diagnosis and treatment methods Diabetic ketosidosis and Hyperglycemia hyperosmotic state.
This section also includes Figure 6.2, which I really like. It's the person that was meant to help us make decisions A1c I think our patient's target is better than the previous patients we had. It is a painting and shows how people choose A1C targets as they change in terms of their individual health and functional states. I recommend looking at this. This is because I think it's more visual and perhaps easier to understand than the previous approaches to doing this.
Section 7 is titled ” Diabetes Techniquesdefinitely my favorite section. I happen to love diabetes techniques. Because I think it really helps my patients. They recommend that diabetes techniques be launched early, even at diagnosis. I'll try to start it as soon as possible, as I think it will help patients understand diabetes better from the start.
They were talking about all the new research in this field, and there was a lot. Much of the data sees the use of automated things Insulin Delivery systems, and most studies, have confirmed their usefulness and safety. They have a new table containing descriptions of commercially available continuous glucose monitoring (CGM) devices currently available. They recommend using CGM if possible in patients with type 2 diabetes who are not taking insulin or on drugs that can cause hypoglycemia.
Section 8 is titled ” Obesity and weight management for the prevention and treatment of type 2 diabetes. “They don't change much from the perspective of knowing how to do it, but if the body mass index is uncertain, we recommend using additional measurements of body fat distribution.
They then talk about closely watching and surveillance of patients when losing weight obesity-Anthropometric measurements associated with at least every 3 months during aggressive weight management therapy.
They talk about weight stigma and prejudice against people living in larger bodies. I think that is very important because patients often feel judged and we don't want them to feel that way. They will discuss the need to screen for malnutrition as explained above and make sure that people do not lose too much weight or are too much weight. We then talk about continuing weight control medication beyond the initial weight loss so that weight loss is maintained.
Regarding Section 9, Pharmacological approaches to blood glucose treatment“I don't think there's anything new, but we're discussing the treatment of metabolic dysfunction-associated steatohepatitis (MASH) using GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists. but, Pioglitazoneor a combination of these.
Figure 9.3, as usual, describes the use of glucose-lowering drugs in the management of type 2 diabetes. I don't think this number is much different from the previous years as it really adds to the concept of treating patients who know cardiovascular disease, kidney disease in different ways. heart failureor individuals at higher risk compared to patients who do not have those characteristics.
I think I really like new people, so I think it's easier, so they'll discuss reducing the risk of metabolic dysfunction-related fatty liver disease (MASLD) or mash. It's a little more comprehensive, but very simple in terms of theme.
Figure 9.4 shows the numbers that we are considering using injectable treatments in patients with type 2 diabetes. The content here is similar to what was in previous years, but is actually presented in a way that looks much easier to read, and how to actually start people with injectable treatments. It probably helps more from the perspective of a practitioner who actually wants to know.
One thing they did was to remove the concept of numbers, which is evidence of Overbasification. We said that if the dose of basal insulin exceeded 0.5 units per kilogram per day, it was evidence of overabsorption. Now they want us to see if there are changes in glucose before or after bedtime as we develop hypoglycemia.
That's the end of Video 2. We will be rejoining Video 3 and Final Section – 2025 of Diabetes Care Standards.
