A Holistic Approach to Diabetes Care

Updated standards of care released by the American Diabetes Association (ADA) for 2023 place a greater emphasis on empowering people with diabetes to self-manage this chronic condition.

“It’s a collaborative approach, as opposed to a prescriptive approach. Patients are the key people on the medical team, which is there to help individuals move forward on their diabetes self-management journey,” said Nancy Ryan, RD, a registered dietitian and certified diabetes care and education specialist.

“It’s not about telling patients what to do,” continued Ryan. “It’s about asking patients with diabetes, ‘What’s working for you? What isn’t working?’ Together we can find ways to support them.”

An estimated 37.3 million people have diabetes, a chronic condition with potentially serious and deadly consequences. Greenwich Hospital has been at the forefront of diabetes care for decades. Its Center for Behavioral and Nutritional Health has an ADA-recognized education program to help patients ramp up their self-management skills. In addition, Greenwich Hospital was the first in Connecticut to receive advanced disease-specific certification from the Joint Commission for inpatient diabetes management.

Located on the ADA website, the standards of care is a living document, continuously updated as new evidence-based information comes forward. Among the latest standards:

• The ADA now recommends overweight individuals lose at least 10 percent of their weight, as opposed to seven percent. “Those who lose 15 percent or more might even see their diabetes go into remission,” said Ryan.
• Psychosocial issues – such as food insecurity, access to health care, the cost of medications – all impact a person’s ability to manage diabetes. This may call for psychologists and social workers to be part of the diabetes care team.
• When prescribing medication, consider all of the individual’s medical needs, not just diabetes. “We have many medications to address blood glucose that can also address the risk of heart attack, stroke and kidney disease,” said Ryan.
• The target blood pressure for people with diabetes decreased to 130/80, down from 140/80. Bad cholesterol (LDL) thresholds also have been lowered to less than 70 for people with diabetes and to less than 55 for those with diabetes who already have cardiovascular disease.

Ryan suggests taking the risk test on the ADA website, even if your blood work is currently normal. “You can get an idea of where you stand and address any concerns with your provider,” she said.