Standards of Care for Diabetes

Health Professional

Once a year, the American Diabetes Association updates their guidelines for diabetes care. They are published in January, and are available online. This year, however, they added a new twist: they have recently announced that they are also publishing their recommendations in a format designed specifically for primary care providers:  The Standards of Medical Care in Diabetes -- 2015: Abridged for Primary Care Providers.  It somehow seem like a Reader's Digest version of the full document,  which is available at  Standards of Medical Care in Diabetes 2015.

In addition to the abridged version of the guidelines, there's a document,  Standards of Medical Care in Diabetes-2015: Summary of Revisions,  which discusses in detail the changes this year.  Here's a recap of what's changed:

  1. The BMI cut point for screening overweight  or obese Asian Americans for prediabetes  and type 2 diabetes was changed  to 23 kg/m2, as  this population is at an  increased risk for diabetes at lower BMI  levels relative to the general population.

  2. The physical activity section was revised  to reflect evidence that all individuals,  including those with diabetes, should  be encouraged to limit the amount of  time they spend being sedentary by  breaking up extended amounts of time  spent sitting.

  3. Due to the increasing use of e-cigarettes,  the Standards were updated to make clear  that e-cigarettes are not supported as an  alternative to smoking or to facilitate  smoking cessation.

  4. Immunization recommendations were  revised to reflect recent Centers for Disease  Control and Prevention guidelines regarding  vaccinations  in older adults.

  1. The ADA now recommends a premeal  blood glucose target of 80-130 mg/dL,
    rather than 70-130 mg/dL, to better reflect new data comparing actual average
    glucose levels with A1C targets.

  2. To provide additional guidance on the  successful implementation of continuous
    glucose monitoring (CGM), there are  new recommendations on assessing
    a patient's readiness for CGM and on  providing ongoing CGM support.

  3. The type 2 diabetes management algorithm  was updated to reflect all of the
    currently available therapies for diabetes  management.

  4. The recommended goal for diastolic  blood pressure was changed from 80
    mmHg to 90 mmHg

  5. Recommendations for statin treatment  and lipid monitoring were revised: Treatment initiation  (and initial statin dose) is now driven primarily by risk status.

  6. The Standards emphasize  that all patients with insensate  feet, foot deformities, or a history of  foot ulcers have their feet examined at  every visit.

  7. The Standards now recommend  a target A1C of less than 7.5% for all pediatric  age-groups

  1. There's a new section with recommendations  related to pregnancy and diabetes, including  recommendations regarding  preconception counseling, medications,  blood glucose targets, and monitoring.

There are lots of other organizations that have developed guidelines, and I've listed some of them at  Diabetes Guidelines.

I'd encourage everyone interested in diabetes to be aware of these guidelines. And be sure your physician is aware of them