Standards of Medical Care in Diabetes

• ABI, ankle-brachial index
• ARB, angiotensin receptor blocker
• CAD, coronary artery disease
• CHD, coronary heart disease
• CSII, continuous subcutaneous insulin injection
• CVD, cardiovascular disease
• FPG, fasting plasma glucose
• GCT, glucose challenge test
• DCCB, dihydropyridine calcium channel blocker
• DCCT, Diabetes Control and Complications Trial
• DKA, diabetic ketoacidosis
• DRS, Diabetic Retinopathy Study
• ECG, electrocardiogram
• eGFR, estimated GFR
• ESRD, end-stage renal disease
• ETDRS, Early Treatment Diabetic Retinopathy Study
• GDM, gestational diabetes mellitus
• GFR, glomerular filtration rate
• HRC, high-risk characteristic
• 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, postprandidial plasma glucose
• SMBG, self-monitoring of blood glucose
• UKPDS, U.K. Prospective Diabetes Study

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 persons 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), Zimmerman (Ed.): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3).

The recommendations included are 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 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.