The updates are available here: http://professional.diabetes.org/content/clinical-practice-recommendations

This site includes the full standards in PDF, and the standards abridged for Primary Care Providers, and other useful tools:

• Full Standards of Care (204 pages)

• Abridged Standards for Primary Care Physicians  (24 pages)

• 2019 Highlights Webcast

• APP will be available Feb 2019

Many of the recommendations stayed consistent with last year’s updates, and continue to promote an individualized, patient-centered, culturally appropriate approach across the lifespan of patients with diabetes.  This year, there was an update to the algorithm for pharmacological management to match the joint ADA/EASD algorithm released in Oct 2018 (see WAFP newsletter from Nov 2018 for simplified chart).  It includes consideration of KEY Factors when choosing therapy, such as ASCVD, HF, CKD, Weight, Cost, and patient preference.  After the first step of lifestyle and metformin, the decision should be based on the most pressing health concern:

• If heart disease is the predominate concern, add GLP1RA or SGLT2I

• If heart failure or chronic kidney disease is the top concern, add an SGLT2I w/supportive evidence (empa/cana if eGFR > 45 ml/min)

• If hypoglycemia is the main concern, choose GLP1RA, SGLT2I, or DPP4I/TZD (less expensive option)

• If cost is the main concern, SU or TZD are the least expensive to date.

There is also an updated table with drug-class specific data.  If you plan to only take a minute to look at the new guidelines, I HIGHLY recommend that you look at Section 9: Pharmacologic Approaches to Glycemic Treatment.  Save/Print out the new treatment algorithm and drug tables available to help with patient specific decision-making.