Diabetes care guias

Position Statement

Standards of Medical Care in Diabetes—2007
AMERICAN DIABETES ASSOCIATION CONTENTS
I. CLASSIFICATION AND DIAGNOSIS, p. S4 A. Classification B. Diagnosis II. SCREENING FOR DIABETES, p. S5 III. DETECTION AND DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS, p. S7 IV. PREVENTION/DELAY OF TYPE 2 DIABETES, p. S7 V. DIABETES CARE, p. S8 A. Initial evaluation B. Management C. Glycemiccontrol 1. Assessment of glycemic control a. Self-monitoring of blood glucose b. A1C 2. Glycemic goals 3. Approach to treatment D. Medical nutrition therapy E. Diabetes self-management education F. Physical activity G. Psychosocial assessment and care H. Referral for diabetes management I. Intercurrent illness J. Hypoglycemia K. Immunization VI. PREVENTION AND MANAGEMENT OF DIABETES COMPLICATIONS,p. S15 A. Cardiovascular disease 1. Hypertension/blood pressure control B. C. D. E. 2. Dyslipidemia/lipid management 3. Antiplatelet agents 4. Smoking cessation 5. C o r o n a r y h e a r t d i s e a s e screening and treatment Nephropathy screening and treatment Retinopathy screening and treatment Neuropathy Foot care

D

VII. DIABETES CARE IN SPECIFIC POPULATIONS, p. S24 A. Children andadolescents B. Preconception care C. Older individuals VIII. D I A B E T E S C A R E I N S P E C I F I C SETTINGS, p. S27 A. Diabetes care in the hospital B. Diabetes care in the school and day care setting C. Diabetes care at diabetes camps D. Diabetes care at correctional institutions E. Emergency and disaster preparedness IX. HYPOGLYCEMIA AND EMPLOYMENT/LICENSURE, p. S33 X. THIRD-PARTY REIMBURSEMENTFOR DIABETES CARE, SELFMANAGEMENT EDUCATION, AND SUPPLIES, p. S33 XI. STRATEGIES FOR IMPROVING DIABETES CARE, p. S33

iabetes 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, beaddressed. 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 mayrequire 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 favorablyaffect 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. I. CLASSIFICATIONAND 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:

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The recommendations in this article arebased on the evidence reviewed in the following publication: Standards of care for diabetes (Technical Review). Diabetes Care 17:1514 –1522, 1994. Originally approved 1988. Most recent review/revision, October 2006. Abbreviations: ABI, ankle-brachial index; AMI, acute myocardial infarction; ARB, angiotensin receptor blocker; CAD, coronary artery disease; CBG, capillary blood glucose; CHD,...