Anatomia Cerebral

Standards ofMedical Care in
Diabetesd2012
Diabetes mellitus is a chronic illness
that requires continuing medical care
and ongoing patient self-management
education and support 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 existsthat supports
a range of interventions to improve
diabetes outcomes.
These standards of care are intended
to provide clinicians, patients, researchers,
payers, and other interested individuals
with the components of diabetes care,
general treatment goals, and tools to evaluate
the quality of care. While individual
preferences, comorbidities, and other patient
factors may requiremodification of
goals, targets that are desirable for most
patients with diabetes are provided. Specifically
titled sections of the standards
address children with diabetes, pregnant
women, and people with prediabetes. These
standards are not intended to preclude
clinical judgment or more extensive evaluation
and management of the patient by
other specialists as needed. For more detailedinformation about management of
diabetes, refer to references 1–3.
The recommendations included are
screening, diagnostic, and therapeutic actions
that are known or believed to favorably
affect health outcomes of patients with
diabetes. A large number of these interventions
have been shown to be cost-effective
(4). A grading system (Table 1), developed
by the American Diabetes Association
(ADA)andmodeled after existingmethods,
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.
These standards of care are revised annually
by the ADA’s multidisciplinary Professional
Practice Committee, incorporating
new evidence.For the current revision,
committeemembers systematically searched
Medline for human studies related to each
subsection and published since 1 January
2010. Recommendations (bulleted at the
beginning of each subsection and also listed
in the “Executive Summary: Standards of
Medical Care in Diabetesd2012”) were revised
based on new evidence or, in some
cases, to clarify the priorrecommendation
or match the strength of the wording to
the strength of the evidence. A table linking
the changes in recommendations to
new evidence can be reviewed at http://
professional.diabetes.org/CPR_Search.
aspx. Subsequently, as is the case for all
Position Statements, the standards of care
were reviewed and approved by the Executive
Committee ofADA’s Board ofDirectors,
which includes healthcare professionals,
scientists, and lay people.
Feedback from the larger clinical community
was valuable for the 2012 revision
of the standards. Readers who wish to
comment on the “Standards of Medical
Care in Diabetesd2012” are invited to do
so at http://professional.diabetes.org/
CPR_Search.aspx.
Members of the Professional Practice
Committee disclose all potential financial
conflictsof interest with industry. These
disclosures were discussed at the onset of
the standards revision meeting. Members of
the committee, their employer, and their
disclosed conflicts of interest are listed in the
“Professional PracticeCommittee Members”
table (see pg. S109). The American Diabetes
Association funds development of the
standards and all its position statements
out of itsgeneral revenues and does not utilize
industry support for these purposes.
I. CLASSIFICATION AND
DIAGNOSIS
A. Classification
The classification of diabetes includes four
clinical classes:
c Type 1 diabetes (results from b-cell
destruction, usually leading to absolute
insulin deficiency)
c Type 2 diabetes (results from a progressive
insulin secretory defect on the
background of insulin...