S T A T E M E N T
Standards of Medical Care in Diabetesd2012
iabetes 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, 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, 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 patientfactors may require modiﬁcation 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 moredetailed information 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) 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. These standards of care are revised annually by the ADA’s multidisciplinary Professional Practice Committee, incorporating
new evidence.For the current revision, committee members 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 prior recommendation ormatch 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 of ADA’s Board of Directors, which includes health careprofessionals, 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 conﬂicts of 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 Practice Committee Members” table (see pg. S109). The American Diabetes Association funds development of the standards and all its position statements out of its general revenues and does not utilizeindustry support for these purposes. I. CLASSIFICATION AND DIAGNOSIS A. Classiﬁcation The classiﬁcation of diabetes includes four clinical classes:
Type 1 diabetes (results from b-cell destruction, usually leading to absolute insulin deﬁciency) Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance) Other speciﬁc types of...