As it happens every December, I look forward to receiving an email about the updated Standards of Medical Care for Diabetes, published by the American Diabetes Association. It is always a good read to learn the minor and/or major revisions to recommendations in order to educate healthcare professionals and implement into clinical practice at the start of the new year. This year, there are some tweaks within the guidelines.
As a pharmacist, I wanted to provide a brief review regarding pharmacotherapy updates in the 2017 guidelines, especially for those who are not able to listen to the upcoming AADE webinar on January 26. Learn more.
In the meantime, here are the highlights of the ADA Standards of Medical Care for Diabetes regarding pharmacotherapy with additional notes:
- There is published literature regarding the link between long-term metformin therapy and vitamin B12 deficiency. In the 2017 ADA guidelines, periodic monitoring of vitamin B 12 measurements is recommended for individuals taking metformin over a long period of time. If vitamin B12 deficiency is present, then supplementation is warranted.
- 2017 may be the year of biosimilar products, as these agents have been approved by the Food and Drug Administration. Biosimilar products are very similar to a reference product and they are not clinically different in regards to efficacy and safety. The 2017 ADA guidelines have added a new section regarding biosimilar insulin, as Lilly’s product – Basalglar –recently became available for use.
- Due to recent evidence on cardiovascular outcomes, empagliflizon and liraglutide are recommended for use among people with established cardiovascular disease. Both of these agents are shown to reduce the risk of mortality and may be a preferred option in this specific patient population.
- A figure was with recommendations regarding antidiabetic agents was developed and published in the 2017 ADA guidelines. The figure is similar to the 2015 ADA/EASD figures on the treatment of type 2 diabetes, but was updated with the consideration of rising insulin product costs. Additional tables are included regarding insulin and non-insulin products with average costs (i.e., mean average wholesale price).
- Combination injectable therapy was updated to include the available options of bolus insulin, GLP-1 receptor agonist, or change to premixed insulin, following basal insulin. This update reflects the noninferiority evidence of the comparisons for basal-bolus insulin, basal insulin plus GLP-1 receptor agonist, premixed insulin.
About the Author
Jennifer Clements received her Doctorate of Pharmacy from Campbell University in 2006 and completed a primary care residency at a Veterans Affairs Medical Center in 2007. She is also a certified diabetes educator and board certified in pharmacotherapy. Currently, she is the Interim Chair and Associate Professor in the Department of Pharmacy Practice at Presbyterian College School of Pharmacy.