Standards of Care for Diabetes

Dr. Bill Quick Health Pro
  • Everyone with diabetes must wonder once in a while what the experts think is the best way to manage their diabetes. (Of course, the definition of “expert” is always open to question – a definition that I once heard is “An expert is someone who comes from over 100 miles away, who brings slides, and is a Son of a B****”.)


    For diabetes, the experts are the folks who write the Standards of Medical Care in Diabetes, which are published annually by the American Diabetes Association. These documents, which go into great detail to describe what is the current thinking on best practices on just about everything to do with diabetes, are written by experts, reviewed by experts, and updated annually in a Supplement to the journal Diabetes Care. Besides these Standards, the experts also review and revise other documents called Position Statements which cover some other topics that aren’t addressed in great detail in the “Standards,”  such as Diabetes Care in the School and Day Care Setting and Diabetes and Driving. Sometimes these Position Statements remain the same from one year to the next, and other times they may undergo major changes as experts’ opinions change about a particular topic. In fact, some Position Statements may more-or-less disappear: for instance, you won’t find a previous Position Statement from the early 1990’s, entitled “Urine Glucose and Ketone Determinations," unless you look hard: it is still available at Diabetes Care if you search.

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    Another, that I wish the ADA had continued to update as a separate document, is Aspirin Therapy in Diabetes -- it’s no longer a separate document; the information about aspirin use is now buried on the third page of the 2013 version of the Standards.


    And there’s one concept that the ADA doesn’t fully discuss: empowering the diabetes patient to become an active partner in their own diabetes care (self-management). In fact, the only mention of the word “empower” this year is in the discussion of pregnancy planning: “The goals of preconception care are to... involve and empower the patient in the management of her diabetes...” Oh well. Maybe next year?


    Fortunately, each year the ADA also publishes an Executive Summary of what’s in the Standards of Medical Care in Diabetes, and also includes a document that describes the current year’s changes; this can be found at the Summary of Revisions for the 2013 Clinical Practice Recommendations.


    The 2013 version of the Standards of Care are now available on-line as well as in print copy. Major changes for this year have been announced in an ADA press release, New Standards of Care Suggest Less Intensive Blood Pressure Goals for People with Diabetes. BTW, the title of the press release is somewhat misleading, as the revised Standards also  clarify how people with type 1 diabetes should test their blood glucose levels.


    The revised BP recommendations raise the treatment goal for high blood pressure from < 130 mm Hg to < 140 mm Hg, based on several new studies. The new recommendation for BG testing for people with T1D who are on multiple daily insulin injections,  or using insulin pumps, should “test prior to meals and snacks, occasionally after eating, at bedtime, before exercise, when they suspect low blood glucose, after treating low blood glucose levels until they return to normal and prior to critical tasks such as driving.”


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    Your physician and diabetes nurse educator should be aware that the ADA Standards exist, and are easily available on-line as both standard HTML format and as PDFs. And of course you can review your treatment against the Standards, and discuss the experts’ opinions with your diabetes team. 

Published On: December 26, 2012