Standards of Medical Care in Diabetes—2014
- American Diabetes Association
Diabetes mellitus is a complex, chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control. Ongoing patient self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications. Significant evidence exists that supports a range of interventions to improve diabetes outcomes.
The American Diabetes Association’s (ADA’s) 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. The Standards of Care recommendations are not intended to preclude clinical judgment and must be applied in the context of excellent clinical care and with adjustments for individual preferences, comorbidities, and other patient factors. For more detailed information about management of diabetes, refer to references 1,2.
The recommendations include screening, diagnostic, and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. Many of these interventions have also been shown to be cost-effective (3). A grading system (Table 1) developed by ADA and modeled after existing methods was used to clarify and codify the evidence that forms the basis for the recommendations. The letters A, B, C, or E show the evidence level that supports each recommendation. The Standards of Care conclude with evidence and recommendations for strategies to improve the process of diabetes care. It must be emphasized that clinical evidence and expert recommendations alone cannot improve patients’ lives, but must be effectively translated into clinical management.
I. Classification and Diagnosis
Diabetes can be classified into four clinical categories:
Type 1 diabetes (due to β-cell destruction, usually leading to absolute insulin deficiency)
Type 2 diabetes (due to a progressive insulin secretory defect on the background …