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© 2006 by the American Diabetes Association
© 2006 by the American Diabetes Association, Inc.
POSITION STATEMENT |
Standards of Medical Care in Diabetes–2006
American Diabetes Association
Abbreviations: ABI, ankle-brachial index • AMI, acute myocatdial infarction • ARB, angiotensin receptor blocker • CAD, coronary artery disease • CBG, capillary blood glucose • CHD, coronary heart disease • CHF, congestive heart failure • CKD, chronic kidney disease • CVD, cardiovascular disease • DCCB, dihydropyridine calcium channel blocker • DCCT, Diabetes Control and Complications Trial • DKA, diabetic ketoacidosis • DMMP, diabetes medical management plan • DPN, distal symmetric polyneuropathy • DPP, Diabetes Prevention Program • DRI, dietary reference intake • DRS, Diabetic Retinopathy Study • DSME, diabetes self-management education • DSMT, diabetes self-management training • ECG, electrocardiogram • ESRD, end-stage renal disease • ETDRS, Early Treatment Diabetic Retinopathy Study • FDA, Food and Drug Administration • FPG, fasting plasma glucose • GDM, gestational diabetes mellitus • GFR, glomerular filtration rate • HRC, high-risk characteristic • ICU, intensive care unit • IFG, impaired fasting glucose • IGT, impaired glucose tolerance • MNT, medical nutrition therapy • NPDR, nonproliferative diabetic retinopathy • OGTT, oral glucose tolerance test • PAD, peripheral arterial disease • PDR, proliferative diabetic retinopathy • PPG, postprandial plasma glucose • RDA, recommended dietary allowance • SMBG, self-monitoring of blood glucose • TZD, thiazolidinedione • UKPDS, U.K. Prospective Diabetes Study
| The first 300 words of the full text of this article appear below. |
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CONTENTS |
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I. CLASSIFICATION AND DIAGNOSIS, p. S4
A. Classification
B. Diagnosis
II. SCREENING FOR DIABETES, p. S5
III. DETECTION AND DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS, p. S7
IV. PREVENTION/DELAY OF TYPE 2 DIABETES, p. S7
V. DIABETES CARE, p. S8
A. Initial evaluation
B. Management
C. Glycemic control
1. Assessment of glycemic control
a. Self-monitoring of blood glucose
b. A1C
2. Glycemic goals
D. Medical nutrition therapy
E. Diabetes self-management education
F. Physical activity
G. Psychosocial assessment and care
H. Referral for diabetes management
I. Intercurrent illness
J. Hypoglycemia
K. Immunization
VI. PREVENTION AND MANAGEMENT OF DIABETES COMPLICATIONS, p. S17
A. Cardiovascular disease
1. Hypertension/blood pressure control
2. Dyslipidemia/lipid management
3. Antiplatelet agents
4. Smoking cessation
5. Coronary heart disease screening and treatment
B. Nephropathy screening and treatment
C. Retinopathy screening and treatment
D. Neuropathy screening and treatment
E. Foot care
VII. DIABETES CARE IN SPECIFIC POPULATIONS, p. S26
A. Children and adolescents
B. Preconception care
C. Older individuals
VIII. DIABETES CARE IN SPECIFIC SETTINGS, p. S29
A. Diabetes care in the hospital
B. Diabetes care in the school and day care setting
C. Diabetes care at diabetes camps
D. Diabetes management in correctional institutions
IX. HYPOGLYCEMIA AND EMPLOYMENT/LICENSURE, p. S34
X. THIRD-PARTY REIMBURSEMENT FOR DIABETES CARE, SELF-MANAGEMENT EDUCATION, AND SUPPLIES, p. S34
XI. STRATEGIES FOR IMPROVING DIABETES CARE, p. S34
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes.
These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals,
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I. CLASSIFICATION AND DIAGNOSIS |
|---|
A. Classification
B. Diagnosis
Recommendations
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II. SCREENING FOR DIABETES |
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Recommendations
Type 1 diabetes
Type 2 diabetes
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III. DETECTION AND DIAGNOSIS OF GDM |
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Recommendations
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IV. PREVENTION/DELAY OF TYPE 2 DIABETES |
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Recommendations
Lifestyle modification
Pharmacological interventions
Lifestyle or medication?
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V. DIABETES CARE |
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A. Initial evaluation
B. Management
C. Glycemic control
1. Assessment of glycemic control.
a. Self-monitoring of blood glucose
b. A1C
Recommendations
2. Glycemic goals
Recommendations
D. MNT
Recommendations
Weight management (37)
Dietary carbohydrate (36)
Dietary protein
Dietary fat
Optimal macronutrient mix
Fiber
Reduced calorie sweetners
Antioxidants
Chromium
Alcohol
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E. DSME |
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Recommendations
Evidence for the benefits of DSME
The national standards for DSME
Reimbursement for DSME
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F. Physical activity |
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Recommendations
Indications for graded exercise test with electrocardiogram monitoring
Definitions
Effects of structured exercise interventions on glycemic control and body weight in type 2 diabetes
Frequency of exercise
Evaluation of the diabetic patient before recommending an exercise program
Exercise in the presence of nonoptimal glycemic control
Hyperglycemia.
Hypoglycemia.
Exercise in the presence of specific long-term complications of diabetes
Retinopathy.
Peripheral neuropathy.
Autonomic neuropathy.
Microalbuminuria and nephropathy.
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G. Psychosocial assessment and care |
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Recommendations
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H. Referral for diabetes management |
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I. Intercurrent illness |
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J. Hypoglycemia |
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Recommendations
|
K. Immunization |
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Recommendations
|
VI. PREVENTION AND MANAGEMENT OF DIABETES COMPLICATIONS |
|---|
A. CVD
1. Hypertension/blood pressure control
Recommendations
2. Dyslipidemia/lipid management
Recommendations
3. Antiplatelet agents
Recommendations
4. Smoking cessation
Recommendations
5. CHD screening and treatment
Recommendations
B. Nephropathy screening and treatment
Recommendations
General recommendations
Screening
Treatment
C. Retinopathy screening and treatment
Recommendations
General recommendations
Screening
Treatment
D. Neuropathy screening and treatment (174,175)
Recommendations
Diagnosis of neuropathy
Diabetic autonomic neuropathy (176)
Symptomatic treatments
DPN.
Tricyclic drugs.
Anticonvulsants.
Other agents.
Treatment of autonomic neuropathy
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E. Foot care |
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Recommendations
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VII. DIABETES CARE IN SPECIFIC POPULATIONS |
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A. Children and adolescents
1. Type 1 diabetes
a. Glycemic control.
b. Screening and management of chronic complications in children and adolescents with type 1 diabetes.
c. Other issues.
2. Type 2 diabetes
B. Preconception care
Recommendations
C. Older individuals
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VIII. DIABETES CARE IN SPECIFIC SETTINGS |
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A. Diabetes care in the hospital
Recommendations
1. Blood glucose targets
a. General medicine and surgery.
b. CVD and critical care.
c. Cardiac surgery.
d. Critical care.
e. Acute neurological disorders.
2. Treatment options
a. Oral diabetes agents.
b. Insulin.
3. Self-management in the hospital
4. Preventing hypoglycemia
5. Diabetes care providers
6. DSME
7. MNT
8. Bedside blood glucose monitoring
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B. Diabetes care in the school and day care setting (179) |
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Recommendations
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C. Diabetes care at diabetes camps (222) |
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Recommendations
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D. Diabetes management in correctional institutions (223) |
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Recommendations
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IX. HYPOGLYCEMIA AND EMPLOYMENT/LICENSURE |
|---|
Recommendations
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X. THIRD-PARTY REIMBURSEMENT FOR DIABETES CARE, SELF-MANAGEMENT EDUCATION, AND SUPPLIES (224) |
|---|
Recommendations
XI. STRATEGIES FOR IMPROVING DIABETES CARE
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