The 2024 ADA guidelines were released a month or two ago and I wanted to take a little time to digest them before providing my big takeaways. The 2023 guidelines saw a major shift in pharmacotherapy with a strong emphasis on compelling indications and recommended increased utilization of GLP-1 Agonists and SGLT2 inhibitors. The 2024 ADA guidelines stuck with that focus for this year and so there aren’t a tremendous amount of changes in Type 2 diabetes pharmacotherapy but there are some need-to-know items you should be aware of.

2024 Diabetes Guidelines Free PDF

My good friend Derek Borkowski and his team at Pyrls.com have an excellent (FREE) PDF that summarizes the Type 2 diabetes treatment algorithm. Simply following this link and providing an email will get you access to this great resource!

My Takeaways – Important Changes In The Guidelines

Continuous Glucose Monitors are all the rage right now and the guidelines capture this. CGM is recommended for all patients with type 1 diabetes. “Initiation of continuous glucose monitoring (CGM) should be offered to people with type 1 diabetes early in the disease, even at time of diagnosis.” In clinical practice, I anticipate that we will be seeing more and more utilization in type 2 diabetes as well starting with a heavier focus on those patients already taking insulin. I think all healthcare professionals must understand and learn this new(ish) technology.

There’s been more and more emphasis (and buzz) on weight management medications so the 2024 ADA Guidelines discuss the use of GLP-1 agonists more than they ever have. As a reminder, semaglutide and tirzepatide are noted to have the highest efficacy in weight loss. The free Pyrls.com PDF on type 2 diabetes management outlines this beautifully.

Teplizumab was approved in 2022 and is highlighted in the diabetes guidelines. Teplizumab is indicated for delaying the onset of type 1 diabetes in at-risk individuals.

Bempedoic acid makes an appearance in the ADA Standards of Care. I have covered this medication on a previous episode of the Real Life Pharmacology Podcast. Here’s what the recommendations say about this medication.

Recommendation 10.24 was added to include bempedoic acid treatment for people with diabetes and without established cardiovascular disease who are intolerant to statin therapy. In addition, Recommendation 10.28b recommends bempedoic acid or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor therapy with monoclonal antibody treatment or inclisiran siRNA as alternative cholesterol-lowering therapy. A new subsection, “Intolerance to Statin Therapy,” was added to expand on these updates.

ADA 2024 Standards of Care

RSV vaccination is also critical for diabetes patients who are 60 years of age or older. These vaccines are new to the market in the last year or two and now make an appearance in the 2024 ADA Standards of Care. We have previously compared and contrasted the two available vaccines in a previous post. The guidelines also emphasize other respiratory vaccinations like influenza and COVID-19 in our at-risk diabetes patient population.

There you have it; my big takeaways on the 2024 diabetes guidelines! What other thoughts do you have on the updates this year?

Eric Christianson, PharmD, BCPS, BCGP