Standards of Medical Care in Diabetes—2008

• ABI, ankle-brachial index
• ACE, angiotensin-converting enzyme
• ADAG, A1C-Derived Average Glucose
• ARB, angiotensin receptor blocker
• CAD, coronary artery disease
• CBG, capillary blood glucose
• CHD, coronary heart disease
• CHF, congestive heart failure
• CKD, chronic kidney disease
• CMS, Centers for Medicare and Medicaid Services
• CSII, continuous subcutaneous insulin infusion
• CVD, cardiovascular disease
• DCCT, Diabetes Control and Complications Trial
• DKA, diabetic ketoacidosis
• DMMP, diabetes medical management plan
• DPN, distal symmetric polyneuropathy
• DPP, Diabetes Prevention Program
• DRS, Diabetic Retinopathy Study
• DSME, diabetes self-management education
• DSMT, diabetes self-management training
• eAG, estimated average glucose
• ECG, electrocardiogram
• EDIC, Epidemiology of Diabetes Interventions and Complications
• ERP, education recognition program
• ESRD, end-stage renal disease
• ETDRS, Early Treatment Diabetic Retinopathy Study
• FDA, Food and Drug Administration
• FPG, fasting plasma glucose
• GDM, gestational diabetes mellitus
• GFR, glomerular filtration rate
• ICU, intensive care unit
• IFG, impaired fasting glucose
• IGT, impaired glucose tolerance
• MICU, medical ICU
• MNT, medical nutrition therapy
• NDEP, National Diabetes Education Program
• NPDR, nonproliferative diabetic retinopathy
• OGTT, oral glucose tolerance test
• PAD, peripheral arterial disease
• PDR, proliferative diabetic retinopathy
• PPG, postprandial plasma glucose
• RAS, renin-angiotensin system
• RDA, recommended dietary allowance
• SICU, surgical ICU
• SMBG, self-monitoring of blood glucose
• TSH, thyroid-stimulating hormone
• TZD, thiazolidinedione
• 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 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 refs. 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 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.