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Diabetes Care 30:S4-S41, 2007
DOI: 10.2337/dc07-S004
© 2007 by the American Diabetes Association
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Position Statements
Position Statement

Standards of Medical Care in Diabetes—2007

American Diabetes Association

Abbreviations: ABI, ankle-brachial index • AMI, acute myocardial 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 • CMS, Centers for Medicare and Medicaid Services • CSII, continuous subcutaneous insulin infusion • 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 • NDEP, National Diabetes Education Program • 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.


   INTRODUCTION
 
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, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to refs. 1–3.

The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.


View this table:



  		Table 1— ADA evidence grading system for clinical practice recommendations

 

   I. CLASSIFICATION AND DIAGNOSIS
 
A. Classification
In 1997, ADA issued new diagnostic and classification criteria (4); in 2003, modifications were made regarding the diagnosis of impaired fasting glucose (IFG) (5). The classification of diabetes includes four clinical classes:
  • Type 1 diabetes (results from ß-cell destruction, usually leading to absolute insulin deficiency)
  • Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance)
  • Other specific types of diabetes due to . . . [Full Text of this Article]

B. Diagnosis
Recommendations

   II. SCREENING FOR DIABETES
 
Recommendations
Type 1 diabetes
Type 2 diabetes

   III. DETECTION AND DIAGNOSIS OF GDM
 
Recommendations

   IV. PREVENTION/DELAY OF TYPE 2 DIABETES
 
Recommendations
Lifestyle modification
Lifestyle or medication?

   V. DIABETES CARE
 
A. Initial evaluation
B. Management
C. Glycemic control
Recommendations
Recommendations
Recommendations

   D. MNT (42)
 
Recommendations
Diabetes and obesity management
Fat intake
Carbohydrate intake
Other nutrition recommendations

   E. DSME
 
Recommendations
Evidence for the benefits of DSME
The national standards for DSME
Reimbursement for DSME

   F. Physical activity
 
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.

   G. Psychosocial assessment and care
 
Recommendations

   H. Referral for diabetes management
 

   I. Intercurrent illness
 

   J. Hypoglycemia
 
Recommendations

   K. Immunization
 
Recommendations

   VI. PREVENTION AND MANAGEMENT OF DIABETES COMPLICATIONS
 
A. CVD
Recommendations
Screening and diagnosis
Goals
Treatment
Recommendations
Screening
Treatment recommendations and goals
Recommendations
Recommendations
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 (171,172)
 
Recommendations
Diagnosis of neuropathy
Diabetic autonomic neuropathy (173)
Symptomatic treatments
DPN
Treatment of autonomic neuropathy

   E. Foot care
 
Recommendations

   VII. DIABETES CARE IN SPECIFIC POPULATIONS
 
A. Children and adolescents
a. Glycemic control.
b. Screening and management of chronic complications in children and adolescents with type 1 diabetes.
Recommendations
Recommendations
Recommendations
Recommendations
Recommendations
c. Other issues.
2. Type 2 diabetes

   B. Preconception care
 
Recommendations

   C. Older individuals
 

   VIII. DIABETES CARE IN SPECIFIC SETTINGS
 
A. Diabetes care in the hospital
Recommendations
1. Blood glucose targets
2. Treatment options
3. Self-management in the hospital
4. Preventing hypoglycemia
5. Diabetes care providers
6. DSME
7. MNT
8. Bedside blood glucose monitoring
9. Continuous blood glucose monitoring

   B. Diabetes care in the school and day care setting (184)
 
Recommendations
C. Diabetes care at diabetes camps (231)
Recommendations
D. Diabetes management in correctional institutions (232)
Recommendations
E. Emergency and disaster preparedness

   IX. HYPOGLYCEMIA AND EMPLOYMENT/LICENSURE
 
Recommendations

   X. THIRD-PARTY REIMBURSEMENT FOR DIABETES CARE, SELF-MANAGEMENT EDUCATION, AND SUPPLIES (233)
 
Recommendations

   XI. STRATEGIES FOR IMPROVING DIABETES CARE
 

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