ADA urges clinicians not to use the word diabetic to describe people with diabetes, among other guideline changes

The word “diabetic” should no longer be used to describe people with diabetes, according to the 2016 revisions for the Standards of Medical Care in Diabetes, a document published by the American Diabetes Association (ADA).
The policy, which works “in alignment with the American Diabetes Association’s (ADA’s) position that diabetes does not define people,” according to a summary of the revisions, is one of several noteworthy changes. These particular changes affect care only in the US, but they could influence future changes in the UK.
The ADA’s Standards of Medical Care in Diabetes “is intended to provide clinicians, patients, researchers, payers, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care,” says the introduction to the 2016 edition.
Diagnostic testing
In addition to condemning the use of “diabetic” as a nou, the 2016 revisions also emphasise the equal importance of different forms of diagnostic testing.
“The order and discussion of diagnostic tests (fasting plasma glucose, 2-h plasma glucose after a 75g oral glucose tolerance test, and [HbA1c] criteria) were revised to make it clear that no one test is preferred over another for diagnosis.”
The ADA also advises that all adults should be tested for type 2 diabetes at the age of 45, regardless of body mass index (BMI). This is to “clarify the relationship between age, BMI, and risk for type 2 diabetes and prediabetes.”
Mental health and diabetes
The document pays significant attention to the issue of mental health and diabetes. It identifies the greater risk of mental health disorders associated with diabetes:
“Severe mental disorder that includes schizophrenia, bipolar disorder, and depression is increased 1.7-fold in people with diabetes. The prevalence of type 2 diabetes is two-three times higher in people with schizophrenia, bipolar disorder, and schizoaffective disorder than in the general population.
“A meta-analysis showed a significantly increased risk of depression […] and, in turn, depression was associated with a significantly increased risk of diabetes.”
To address these issues, the document urges clinicians not to neglect the psychological side of diabetes – even if they don’t feel qualified to treat it. By building a relationship with their patient, and thereby nurturing an environment in which psychological problems can be discussed, clinicians “increase the likelihood of the patient accepting the referral for other services.”
Clinicians are also encouraged not to wait until specific problems occur before incorporating psychological assessment into their treatment. The document states: “It is preferable to incorporate psychological assessment and treatment into routine care rather than waiting for a specific problem or deterioration in metabolic or psychological status.”
Diet and diabetes
On the subject of diet, the guidelines are unchanged; they remain inconclusive.
“Studies examining the ideal amount of carbohydrate intake for people with diabetes are inconclusive, although monitoring carbohydrate intake and considering the blood glucose response to dietary carbohydrate are key for improving post-prandial glucose control. Although in some studies lowering the glycemic load of consumed carbohydrate has demonstrated [HbA1c] reduction of -0.2 per cent to -0.5 per cent, a systematic review found that whole-grain consumption was not associated with improvements in glycemic control in type 2 diabetes.
“Limited research exists concerning the ideal amount of fat for individuals with diabetes […] The type of fatty acids consumed is more important than total amount of fat when looking at metabolic goals and CVD risk. Multiple randomised controlled trials including patients with type 2 diabetes have reported that a Mediterranean-style eating patter, rich in monounsaturated fats, can improve both glycemic control and blood lipids.”
The lack of clear conclusion regarding diet and blood glucose control suggests that dietary advice should be made according to the needs of individual patients.
A summary of the revisions are published in the journal Diabetes Care. The full document is available here.