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:
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.
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
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
Immunization recommendations were
revised to reflect recent Centers for Disease
Control and Prevention guidelines regarding
in older adults.
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.
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.
The type 2 diabetes management algorithm
was updated to reflect all of the
currently available therapies for diabetes
The recommended goal for diastolic
blood pressure was changed from 80
mmHg to 90 mmHg
Recommendations for statin treatment
and lipid monitoring were revised: Treatment initiation
(and initial statin dose) is now driven primarily by risk status.
The Standards emphasize
that all patients with insensate
feet, foot deformities, or a history of
foot ulcers have their feet examined at
The Standards now recommend
a target A1C of less than 7.5% for all pediatric
- There's a new section with recommendations
related to pregnancy and diabetes, including
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
I'd encourage everyone interested in diabetes to be aware of these guidelines. And be sure your physician is aware of them