HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Erratum (v28,p990) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Search for Related Content PubMed PubMed Citation Social Bookmarking                What's this?

Standards of Medical Care in Diabetes

Abbreviations: ABI, ankle-brachial index • AMI, acute myocardial infarction • ARB, angiotensin receptor blocker • CAD, coronary artery disease • CBG, capillary blood glucose • CHD, coronary heart disease • CHF, congestive heart failure • CSII, continuous subcutaneous insulin injection • CVD, cardiovascular disease • DCCB, dihydropyridine calcium channel blocker • DCCT, Diabetes Control and Complications Trial • DKA, diabetic ketoacidosis • DPP, Diabetes Prevention Program • DSME, diabetes self-management education • DRS, Diabetic Retinopathy Study • ECG, electrocardiogram • eGFR, estimated glomerular filtration rate • ESRD, end-stage renal disease • ETDRS, Early Treatment Diabetic Retinopathy Study • FPG, fasting plasma glucose • GCT, glucose challenge test • GDM, gestational diabetes mellitus • GFR, glomerular filtration rate • HRC, high-risk characteristic • ICU, intensive care unit • IFG, impaired fasting glucose • IGT, impaired glucose tolerance • MNT, medical nutrition therapy • NPDR, nonproliferative diabetic retinopathy • OGTT, oral glucose tolerance test • PAD, peripheral arterial disease • PDR, proliferative diabetic retinopathy • PPG, postprandial plasma glucose • SMBG, self-monitoring of blood glucose • UKPDS, U.K. Prospective Diabetes Study

The first 300 words of the full text of this article appear below.

	CONTENTS

 

1. CLASSIFICATION AND DIAGNOSIS
   1. Classification
      
   2. Diagnosis
      
   
   
2. SCREENING FOR DIABETES
   
3. DETECTION AND DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS (GDM)
   
4. PREVENTION/DELAY OF TYPE 2 DIABETES
   
5. DIABETES CARE
   1. Initial evaluation
      
   2. Management
      
   3. Glycemic control
      1. Assessment of glycemic control
         1. Self-monitoring of blood glucose
            
         2. A1C
            
         
         
      2. Glycemic goals
         
      
      
   4. Medical nutrition therapy
      
   5. Physical activity
      
   6. Psychosocial assessment and care
      
   7. Referral for diabetes management
      
   8. Intercurrent illness
      
   9. Immunization
      
   
   
6. PREVENTION AND MANAGEMENT OF DIABETES COMPLICATIONS
   1. Cardiovascular disease
      1. Hypertension/blood pressure control
         
      2. Dyslipidemia/lipid management
         
      3. Anti-platelet agents
         
      4. Smoking cessation
         
      5. Coronary heart disease screening and treatment
         
      
      
   2. Nephropathy screening and treatment
      
   3. Retinopathy screening and treatment
      
   4. Foot care
      
   
   
7. DIABETES CARE IN SPECIFIC POPULATIONS
   1. Children and adolescents
      
   2. Preconception care
      
   3. Older individuals
      
   
   
8. DIABETES CARE IN SPECIFIC SETTINGS
   1. Diabetes care in the hospital
      
   2. Diabetes care in the school and day care setting
      
   3. Diabetes care at diabetes camps
      
   4. Diabetes care at correctional institutions
      
   
   
9. HYPOGLYCEMIA AND EMPLOYMENT/LICENSURE
   
10. THIRD-PARTY REIMBURSEMENT FOR DIABETES CARE, SELF-MANAGEMENT EDUCATION, AND SUPPLIES
    
11. STRATEGIES FOR IMPROVING DIABETES CARE
    

Diabetes 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, 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, 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 more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of . . . [Full Text of this Article]

	I. CLASSIFICATION AND DIAGNOSIS

 
A. Classification
B. Diagnosis
Recommendations

	II. SCREENING FOR DIABETES

 
Type 1 diabetes
Type 2 diabetes
Recommendations

	III. DETECTION AND DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS (GDM)

 
Recommendations

	IV. PREVENTION/DELAY OF TYPE 2 DIABETES

 
Lifestyle modification
Pharmacological interventions
Lifestyle or medication?
Recommendations

	V. DIABETES CARE

 
A. Initial evaluation
B. Management
C. Glycemic control
1. Assessment of glycemic control.
a. Self-monitoring of blood glucose.
Recommendations
b. A1C.
Recommendations
2. Glycemic goals.
Recommendations
D. MNT
Goals of MNT that apply to specific situations include the following:
Dietary carbohydrate (35).
Weight management (36).
Recommendations
E. Physical activity
Recommendations
F. Psychosocial assessment and care
Recommendations
G. Referral for diabetes management
H. Intercurrent illness
I. Immunization
Recommendations

	VI. PREVENTION AND MANAGEMENT OF DIABETES COMPLICATIONS

 
A. CVD
1. Hypertension/blood pressure control.
Recommendations
Screening and diagnosis
Goals
Treatment
2. Dyslipidemia/lipid management.
Recommendations
Screening
Treatment recommendations and goals
3. Anti-platelet agents.
Recommendations
4. Smoking cessation.
Recommendations
5. CHD screening and treatment.
Recommendations
B. Nephropathy screening and treatment
Recommendations
General recommendations
Screening
Treatment
C. Retinopathy screening and treatment
Recommendations
General recommendations
Screening
Treatment
D. Foot care
Recommendations

	VII. DIABETES CARE IN SPECIFIC POPULATIONS

 
A. Children and adolescents
1. Type 1 diabetes.
Recommendations
Recommendations
Recommendations Screening
Treatment
Recommendations
c. Other issues.
2. Type 2 diabetes.

	B. Preconception care

 

	Recommendations

 

	C. Older individuals

 

	VIII. DIABETES CARE IN SPECIFIC SETTINGS

 
A. Diabetes care in the hospital
Patients with hyperglycemia fall into three categories:
1. Blood glucose targets
a. General medicine and surgery.
b. CVD and critical care.
c. Cardiac surgery.
d. Critical care.
e. Acute neurological disorders.
2. Treatment options
a. Oral diabetes agents.
b. Insulin.
3. Self-management in the hospital.
4. Preventing hypoglycemia.
5. Diabetes care providers.
6. DSME.
7. MNT.
8. Bedside blood glucose monitoring.
Recommendations
B. Diabetes care in the school and day care setting (131)
Recommendations
C. Diabetes care at diabetes camps (173)
Recommendations
D. Diabetes care in correctional institutions (174)
Recommendations

	IX. HYPOGLYCEMIA AND EMPLOYMENT/LICENSURE (175)

 
Recommendation

	X. THIRD-PARTY REIMBURSEMENT FOR DIABETES CARE, SELF-MANAGEMENT EDUCATION, AND SUPPLIES (176)

 
Recommendations

	XI. STRATEGIES FOR IMPROVING DIABETES CARE

 

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				Yin Xu, C. Savage, D. Toobert, Wei Pan, and K. Whitmer Adaptation and Testing of Instruments to Measure Diabetes Self-Management in People With Type 2 Diabetes in Mainland China J Transcult Nurs, July 1, 2008; 19(3): 234 - 242. [Abstract] [PDF]

				M. E. Matheny, T. D. Sequist, A. C. Seger, J. M. Fiskio, M. Sperling, D. Bugbee, D. W. Bates, and T. K. Gandhi A Randomized Trial of Electronic Clinical Reminders to Improve Medication Laboratory Monitoring J. Am. Med. Inform. Assoc., July 1, 2008; 15(4): 424 - 429. [Abstract] [Full Text] [PDF]

				E. S. Huang, Q. Zhang, N. Gandra, M. H. Chin, and D. O. Meltzer The Effect of Comorbid Illness and Functional Status on the Expected Benefits of Intensive Glucose Control in Older Patients with Type 2 Diabetes: A Decision Analysis Ann Intern Med, July 1, 2008; 149(1): 11 - 19. [Abstract] [Full Text] [PDF]

				J. Galle, E. Schwedhelm, S. Pinnetti, R. H. Boger, C. Wanner, and on behalf of the VIVALDI investigators Antiproteinuric effects of angiotensin receptor blockers: telmisartan versus valsartan in hypertensive patients with type 2 diabetes mellitus and overt nephropathy Nephrol. Dial. Transplant., May 1, 2008; (2008) gfn230v1. [Abstract] [Full Text] [PDF]

				D. Giugliano, A. Ceriello, and K. Esposito Glucose metabolism and hyperglycemia Am. J. Clinical Nutrition, January 1, 2008; 87(1): 217S - 222S. [Abstract] [Full Text] [PDF]

				M. Boodhwani, N. R. Sodha, S. Mieno, B. Ramlawi, S.-H. Xu, J. Feng, R. T. Clements, M. Ruel, and F. W. Sellke Insulin treatment enhances the myocardial angiogenic response in diabetes. J. Thorac. Cardiovasc. Surg., December 1, 2007; 134(6): 1453 - 1460. [Abstract] [Full Text] [PDF]

				D. Vincent, A. Pasvogel, and L. Barrera A Feasibility Study of a Culturally Tailored Diabetes Intervention for Mexican Americans Biol Res Nurs, October 1, 2007; 9(2): 130 - 141. [Abstract] [PDF]

				M. Heisler, J. D. Faul, R. A. Hayward, K. M. Langa, C. Blaum, and D. Weir Mechanisms for Racial and Ethnic Disparities in Glycemic Control in Middle-aged and Older Americans in the Health and Retirement Study Arch Intern Med, September 24, 2007; 167(17): 1853 - 1860. [Abstract] [Full Text] [PDF]

				S. M. Donahoe, G. C. Stewart, C. H. McCabe, S. Mohanavelu, S. A. Murphy, C. P. Cannon, and E. M. Antman Diabetes and Mortality Following Acute Coronary Syndromes JAMA, August 15, 2007; 298(7): 765 - 775. [Abstract] [Full Text] [PDF]

				B. Klebe, C. Farmer, R. Cooley, S. de Lusignan, R. Middleton, D. O'Donoghue, J. New, and P. Stevens Kidney disease management in UK primary care: guidelines, incentives and Information Technology Fam. Pract., August 1, 2007; 24(4): 330 - 335. [Abstract] [Full Text] [PDF]

				A. B. Smith, P. O. Udekwu, S. Biswas, E. Harvey, A. Bullock, M. A. Barnes, and S. Allred Implementation of a nurse-driven intensive insulin infusion protocol in a surgical intensive care unit Am. J. Health Syst. Pharm., July 15, 2007; 64(14): 1529 - 1540. [Full Text] [PDF]

				D. Q. Pham, H. Cohen, and V. Chu Inhaled Human [rDNA Origin] Insulin, a Novel Formulation for Diabetes Mellitus J. Clin. Pharmacol., July 1, 2007; 47(7): 890 - 903. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. V. d. Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J. Suppl., June 1, 2007; 9(suppl_C): C3 - C74. [Full Text] [PDF]

				R. Whittemore Culturally Competent Interventions for Hispanic Adults With Type 2 Diabetes: A Systematic Review J Transcult Nurs, April 1, 2007; 18(2): 157 - 166. [Abstract] [PDF]

				J. R. Gavin III Practical Approaches to Insulin Therapy The Diabetes Educator, March 1, 2007; 33(Supplement_3): 66S - 73S. [Full Text] [PDF]

				D. B. Petitti, G. Imperatore, S. L. Palla, S. R. Daniels, L. M. Dolan, A. K. Kershnar, S. Marcovina, D. J. Pettitt, C. Pihoker, and for the SEARCH for Diabetes in Youth Study Group Serum Lipids and Glucose Control: The SEARCH for Diabetes in Youth Study Arch Pediatr Adolesc Med, February 1, 2007; 161(2): 159 - 165. [Abstract] [Full Text] [PDF]

				M. J. Abrahamson A 74-Year-Old Woman With Diabetes JAMA, January 10, 2007; 297(2): 196 - 204. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, L. Ryden, E. Standl, M. Bartnik, G. Van den Berghe, J. Betteridge, M.-J. de Boer, F. Cosentino, B. Jonsson, M. Laakso, et al. Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD) Eur. Heart J., January 1, 2007; 28(1): 88 - 136. [Full Text] [PDF]

				L. E. John, M. P. Kane, R. S. Busch, and R. A. Hamilton Expanded Use of Exenatide in the Management of Type 2 Diabetes Diabetes Spectr, January 1, 2007; 20(1): 59 - 63. [Full Text] [PDF]

				American Diabetes Association Standards of Medical Care in Diabetes--2007 Diabetes Care, January 1, 2007; 30(suppl_1): S4 - S41. [Full Text] [PDF]

				R. Scognamiglio Reply J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1917 - 1917. [Full Text] [PDF]

				S. E. Inzucchi Management of Hyperglycemia in the Hospital Setting N. Engl. J. Med., November 2, 2006; 355(18): 1903 - 1911. [Full Text] [PDF]

				D. Chyun, K. O. Lacey, D. M. Katten, S. Talley, W. J. Price, J. A. Davey, and G. D. Melkus Glucose and Cardiac Risk Factor Control in Individuals With Type 2 Diabetes: Implications for Patients and Providers The Diabetes Educator, November 1, 2006; 32(6): 925 - 939. [Abstract] [Full Text] [PDF]

				M. C. Gulliford, S. Naithani, and M. Morgan Measuring Continuity of Care in Diabetes Mellitus: An Experience-Based Measure Ann. Fam. Med, November 1, 2006; 4(6): 548 - 555. [Abstract] [Full Text] [PDF]

				T. N. Erickson, E. B. Devine, T. S. O'Young, L. J. Hanson, B. French, and C. Brennan Effect of switching medically vulnerable patients with uncontrolled diabetes from isophane insulin human to insulin glargine. Am. J. Health Syst. Pharm., October 1, 2006; 63(19): 1862 - 1871. [Abstract] [Full Text] [PDF]

				M. M. Chitre and S. Burke Treatment Algorithms and the Pharmacological Management of Type 2 Diabetes Diabetes Spectr, October 1, 2006; 19(4): 249 - 255. [Abstract] [Full Text] [PDF]

				P. Barter Options for therapeutic intervention: how effective are the different agents? Eur. Heart J. Suppl., October 1, 2006; 8(suppl_F): F47 - F53. [Abstract] [Full Text] [PDF]

				F. Q. Nuttall, K. Schweim, H. Hoover, and M. C. Gannon Metabolic effect of a LoBAG30 diet in men with type 2 diabetes Am J Physiol Endocrinol Metab, October 1, 2006; 291(4): E786 - E791. [Abstract] [Full Text] [PDF]

				F. C. Brosius III, T. H. Hostetter, E. Kelepouris, M. M. Mitsnefes, S. M. Moe, M. A. Moore, S. Pennathur, G. L. Smith, and P. W.F. Wilson REPRINT Detection of Chronic Kidney Disease in Patients With or at Increased Risk of Cardiovascular Disease: A Science Advisory From the American Heart Association Kidney and Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: Developed in Collaboration With the National Kidney Foundation Hypertension, October 1, 2006; 48(4): 751 - 755. [Abstract] [Full Text] [PDF]

				P. M. Ho, J. S. Rumsfeld, F. A. Masoudi, D. L. McClure, M. E. Plomondon, J. F. Steiner, and D. J. Magid Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med, September 25, 2006; 166(17): 1836 - 1841. [Abstract] [Full Text] [PDF]

				N. I. Parikh, S.-J. Hwang, M. G. Larson, J. B. Meigs, D. Levy, and C. S. Fox Cardiovascular disease risk factors in chronic kidney disease: overall burden and rates of treatment and control. Arch Intern Med, September 25, 2006; 166(17): 1884 - 1891. [Abstract] [Full Text] [PDF]

				T. L. Gruenewald, T. E. Seeman, C. D. Ryff, A. S. Karlamangla, and B. H. Singer From the Cover: Combinations of biomarkers predictive of later life mortality PNAS, September 19, 2006; 103(38): 14158 - 14163. [Abstract] [Full Text] [PDF]

				T. M Reynolds, W S. A Smellie, and P. J Twomey Glycated haemoglobin (HbA1c) monitoring BMJ, September 16, 2006; 333(7568): 586 - 588. [Full Text] [PDF]

				F. C. Brosius III, T. H. Hostetter, E. Kelepouris, M. M. Mitsnefes, S. M. Moe, M. A. Moore, S. Pennathur, G. L. Smith, and P. W.F. Wilson Detection of Chronic Kidney Disease in Patients With or at Increased Risk of Cardiovascular Disease: A Science Advisory From the American Heart Association Kidney and Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: Developed in Collaboration With the National Kidney Foundation Circulation, September 5, 2006; 114(10): 1083 - 1087. [Abstract] [Full Text] [PDF]

				R. J. Koopman, A. G. Mainous III, H. A. Liszka, J. A. Colwell, E. H. Slate, M. A. Carnemolla, and C. J. Everett Evidence of Nephropathy and Peripheral Neuropathy in US Adults With Undiagnosed Diabetes. Ann. Fam. Med, September 1, 2006; 4(5): 427 - 432. [Abstract] [Full Text] [PDF]

				J. Zhang, R. Niaura, J. R. Dyer, B.-J. Shen, J. F. Todaro, J. M. McCaffery, A. Spiro III, and K. D. Ward Hostility and Urine Norepinephrine Interact to Predict Insulin Resistance: The VA Normative Aging Study. Psychosom Med, September 1, 2006; 68(5): 718 - 726. [Abstract] [Full Text] [PDF]

				A. Nicolucci, S. Greenfield, and S. Mattke Selecting indicators for the quality of diabetes care at the health systems level in OECD countries Int. J. Qual. Health Care, September 1, 2006; 18(suppl_1): 26 - 30. [Abstract] [Full Text] [PDF]

				B. H. Sanders, L. M Lubsch, and D. S West Prevalence and Treatment of Metabolic Syndrome in Adolescents with Type 2 Diabetes Ann. Pharmacother., September 1, 2006; 40(9): 1517 - 1521. [Abstract] [Full Text] [PDF]

				S. Barud, T. Marcy, B. Armor, J. Chonlahan, and P. Beach Development and implementation of group medical visits at a family medicine center. Am. J. Health Syst. Pharm., August 1, 2006; 63(15): 1448 - 1452. [Full Text] [PDF]

				W S A Smellie, J Forth, D Bareford, P Twomey, M J Galloway, E C M Logan, S R S Smart, T M Reynolds, and C Waine Best practice in primary care pathology: review 3. J. Clin. Pathol., August 1, 2006; 59(8): 781 - 789. [Abstract] [Full Text] [PDF]

				C. M. Morello, E. B. Zadvorny, M. A. Cording, R. T. Suemoto, J. Skog, and A. Harari Development and clinical outcomes of pharmacist-managed diabetes care clinics. Am. J. Health Syst. Pharm., July 15, 2006; 63(14): 1325 - 1331. [Abstract] [Full Text] [PDF]

				J. E. Elwing, P. J. Lustman, H. L. Wang, and R. E. Clouse Depression, Anxiety, and Nonalcoholic Steatohepatitis Psychosom Med, July 1, 2006; 68(4): 563 - 569. [Abstract] [Full Text] [PDF]

				G. B.B. Kristensen, K. Nerhus, G. Thue, and S. Sandberg Results and Feasibility of an External Quality Assessment Scheme for Self-Monitoring of Blood Glucose Clin. Chem., July 1, 2006; 52(7): 1311 - 1317. [Abstract] [Full Text] [PDF]

				A. Balasubramanyam, D. Hinnen, and W. Polonsky Cardiovascular Event Prevention in the Person With Type 2 Diabetes: Case Examples for Identifying and Treating Multiple Risks The Diabetes Educator, July 1, 2006; 32(Supplement_5): 163S - 173S. [Full Text] [PDF]

				P. P. Dobesh Managing hypertension in patients with type 2 diabetes mellitus. Am. J. Health Syst. Pharm., June 15, 2006; 63(12): 1140 - 1149. [Abstract] [Full Text] [PDF]

				J. Blaauw, M. G. van Pampus, J. J. Van Doormaal, M. R. Fokkema, V. Fidler, A. J. Smit, and J. G. Aarnoudse Increased intima-media thickness after early-onset preeclampsia. Obstet. Gynecol., June 1, 2006; 107(6): 1345 - 1351. [Abstract] [Full Text] [PDF]

				T Hussain, A Bagnall, and J C Agwu NICE guidelines for hyperlipidaemia in children and young people with type I diabetes: time for a rethink? Arch. Dis. Child., June 1, 2006; 91(6): 545 - 545. [Full Text] [PDF]

				S. N. Davis and S. M. Renda Treating to Target in Type 2 Diabetes: A Case Presentation. The Diabetes Educator, June 1, 2006; 32(Supplement_4): 137S - 145S. [Full Text] [PDF]