Patients with type 2 diabetes frequently have comorbid conditions such as hypertension, heart disease, kidney disease, and obesity. 

MD /alert spoke with Robert Gabbay, MD, PhD, chief science and medical officer of the American Diabetes Association, where he discussed ADA guidelines for collaborative, individualized diabetes care especially for patients with comorbidities. 

“The guidelines really reflect a great deal around collaborative care. Diabetes in many cases has really been the prototype disease, it speaks about team-based care and the need to collaborate together to get the best outcomes. Not only is that reflected in our discussion around comorbidity management, but it also we developed the sections that relate to cardiovascular risk reduction in cardiovascular disease, in collaboration with the American College of Cardiology that were part of that effort. More specifically, some of the things that you'll see new are, one thing I'm quite excited about, and a diagram that I think you'll see reproduced a great deal is an overall approach to thinking about diabetes, particularly type two diabetes in a broader sense, and it really speaks to four pillars that need to be attended to and all of that happens on a base of lifestyle management.  

Those four pillars are blood glucose management, which of course is something that's always been there and been an important part of diabetes management, but the second being blood pressure, the third being lipid management, and the fourth, is to really recognize the importance of treatments that specifically reduce cardiovascular disease and renal risk. Those are detailed a great deal throughout the guidelines in specific sections of the standards that speak to that, but also in the overall pharmacological management of type 2 diabetes.  

The other thing I'd like to highlight about comorbidities is there's expanded discussion around what has often been an overlooked or not well thought about comorbidity associated with diabetes, and that's liver disease. Diabetes now is becoming a leading cause of liver disease, whether that's fatty liver disease or NASH, or NAFLD. There's more guidance there on both the diagnosis and management that aligns with some recently published materials. Finally, again, comorbidities being you know, critically important, the other area that there's a good new discussion around is cognitive function, and how that is another comorbidity that needs to be accounted for both from an assessment perspective but also to potentially change management or tailor an individualized treatment based on cognitive function.” 

- Robert Gabbay, MD, PhD, Chief Science and Medical Officer of the American Diabetes Association 

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Collaborative care across a variety of specialties that also puts the individual needs of the patient first are among the most important ways that patients with type 2 diabetes and comorbidities can have the best clinical outcomes. 

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Ways to Access the 2022 Standards of Care  

Full Standards of Medical Care in Diabetes (Standards of Care) 

Abridged Standards of Care 

Standards of Care Mobile App 

Standards of Care Webinar with Dr. Robert Gabbay (with or without CE credit) 

Standards of Care Slide Deck 

Disclosures: Gabbay declared financial ties to drugmakers. More details on 2022 Standards of Care disclosures here.   

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Any views expressed above are the author's own and do not necessarily reflect the views of MD /alert. This transcript was digitally generated and edited for clarity.

Photo Credit: Getty Images