Nutriciòn

P O S I T I O N

S T A T E M E N T

Standards of Medical Care in Diabetes—2010
AMERICAN DIABETES ASSOCIATION

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iabetes 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, beyondglycemic control, be addressed. 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, general treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities,and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. 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 detailed information about management of diabetes, refer to references 1–3. The recommendationsincluded are screening, diagnostic, and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was used to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports eachrecommendation is listed after each recommendation using the letters A, B, C, or E. These standards of care are revised annually by the ADA multidisciplinary Professional Practice Committee, and new evidence is incorporated. Members of the Professional Practice Committee and their disclosed conflicts of interest are listed in the Introduction. Subsequently, as with all position statements, the standardsof care are reviewed and approved

by the Executive Committee of ADA’s Board of Directors. I. CLASSIFICATION AND DIAGNOSIS A. Classification The classification of diabetes includes four clinical classes:
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type 1 diabetes (results from -cell destruction, usually leading toabsolute insulin deficiency) type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance) other specific types of diabetes due to other causes, e.g., genetic defects in -cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis), and drugor chemical-induced diabetes (such as in the treatment of AIDS or afterorgan transplantation) gestational diabetes mellitus (GDM) (diabetes diagnosed during pregnancy)

Originally approved 1988. Most recent review/revision October 2009. DOI: 10.2337/dc10-S011 Abbreviations: ABI, ankle-brachial index; ACCORD, Action to Control Cardiovascular Risk in Diabetes; ADAG, A1C-Derived Average Glucose Trial; ADVANCE, Action in Diabetes and Vascular Disease: Preterax andDiamicron Modified Release Controlled Evaluation; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker; ACT-NOW, ACTos Now Study for the Prevention of Diabetes; BMI, body mass index; CBG, capillary blood glucose; CFRD, cystic fibrosis–related diabetes; CGM, continuous glucose monitoring; CHD, coronary heart disease; CHF, congestive heart failure; CCM, chronic care model; CKD, chronickidney disease; CMS, Centers for Medicare and Medicaid Services; CSII, continuous subcutaneous insulin infusion; CVD, cardiovascular disease; DASH, Dietary Approaches to Stop Hypertension; DCCT, Diabetes Control and Complications Trial; DKA, diabetic ketoacidosis; DMMP, diabetes medical management plan; DPN, distal symmetric polyneuropathy; DPP, Diabetes Prevention Program; DPS, Diabetes...