Exercise Still Key in Diabetes Care

American Diabetes Association standards recommend statins and exercise for patients with diabetes

(RxWiki News) The American Diabetes Associations' new guidelines send a message to patients to get moving and lower cholesterol for better heart health.

The American Diabetes Association (ADA) has just published the annual update to their standards for care of patients with diabetes.

The new recommendations include the use of cholesterol-lowering medications (statins) and regular exercise.

“The big change here is to recommend starting either moderate or high-intensity statins," said Richard W. Grant, MD, PhD, of Kaiser Permanente and Chair of the ADA’s Professional Practice Committee, in a press release.

The statin recommendation is "based on the patient’s risk profile rather than on LDL level,” said Dr. Grant. LDL, or low-density lipoprotein, is known as the "bad" cholesterol.

When a person has diabetes, their body either does not make enough of the hormone insulin (type 1 diabetes) or has become resistant to the insulin their body makes (type 2 diabetes). Insulin helps cells properly use glucose (blood sugar). People with diabetes have too much glucose in their blood, which can lead to health problems.

The new standards recommend moderate-intensity statins for people under age 40 with diabetes. Moderate-intensity statins are also recommended for those between ages 40 and 75 without risk factors for heart disease. High LDL cholesterol, high blood pressure, smoking and obesity are risk factors for heart disease.

Examples of moderate-intensity statins are atorvastatin (brand name Lipitor) taken a doses of 10–20 milligrams, rosuvastatin (brand name Crestor) at 5–10 milligrams, simvastatin (brand name Zocor) at 20–40 milligrams, and several others.

Patients with diabetes who also have heart and blood vessel disease should receive high-intensity statin therapy, according to the guidelines. Those between the ages of 45 and 75 who have risk factors for heart disease should also be given high-intensity statins.

High intensity statins include atorvastatin taken at 40–80 milligrams or rosuvastatin at 20–40 milligrams.

Another change to the standards for care was the recommendation that all people, with or without diabetes, get regular exercise. The ADA recommended that no more than 90 minutes at a time be spent sitting or resting.

Twice weekly resistance training, such as weightlifting, was recommended for people with diabetes.

The ADA also recommended diabetes screening for people who have a body mass index (BMI), a measure of obesity, over 23. A normal BMI is 18.5 to 24.9.

The use of electronic cigarettes to help quit smoking was not recommended by the ADA.

"We've revised our recommendations, as we do every year, to reflect the best and most current research affecting the treatment and care of people with diabetes," said Jane Chiang, MD, ADA Senior Vice President for Medical Affairs and Community Information, in a press statement.

"Ultimately, our goal is to improve the lives of those who are living with this disease," Dr. Chiang said.

The new standards were published Dec. 23 in Diabetes Care.

Review Date: 
December 21, 2014