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ISSN 0149-5992

THE JOURNAL OF CLINICAL AND APPLIED RESEARCH AND EDUCATION

WWW.DIABETES.ORG/DIABETESCARE JANUARY 2018

VOLUME 41 | SUPPLEMENT 1

AMERICAN DIABETES ASSOCIATION

STANDARDS OFMEDICAL CAREIN DIABETES"2018S

U P P L EM E N T 1 [T]he simple wordCaremay sufce to express [the journal's] philosophical mission. The new journal is designed to promote better patient care by serving the expanded needs of all health professionals committed to the care of patients with diabetes. As such, the American Diabetes Association views Diabetes Careas a reafrmation of Francis Weld Peabody's contention that "the secret of the care of the patient is in caring for the patient." - Norbert Freinkel,Diabetes Care, January-February 1978

EDITOR IN CHIEF

Matthew C. Riddle, MD

ASSOCIATE EDITORS

George Bakris, MD

Lawrence Blonde, MD, FACP

Andrew J.M. Boulton, MD

David D'Alessio, MD

Mary de Groot, PhD

Eddie L. Greene, MD

Frank B. Hu, MD, MPH, PhD

Steven E. Kahn, MB, ChB

Sanjay Kaul, MD, FACC, FAHA

Derek LeRoith, MD, PhD

Robert G. Moses, MD

Stephen Rich, PhD

Julio Rosenstock, MD

William V. Tamborlane, MD

Judith Wylie-Rosett, EdD, RD

EDITORIAL BOARD

Nicola Abate, MD

Vanita R. Aroda, MD

Geremia Bolli, MD

John B. Buse, MD, PhD

Robert J. Chilton, DO, FACC, FAHA

Kenneth Cusi, MD, FACP, FACE

Paresh Dandona, MD, PhD

J. Hans DeVries, MD, PhD

Ele Ferrannini, MD

Franco Folli, MD, PhD

Meredith A. Hawkins, MD, MS

Richard Hellman, MD

Norbert Hermanns, PhD, MSc

Irl B. Hirsch, MD, MACP

George S. Jeha, MD

Lee M. Kaplan, MD, PhD

M. Sue Kirkman, MD

Ildiko Lingvay, MD, MPH, MSCS

Harold David McIntyre, MD, FRACPMaureen Monaghan, PhD, CDE

Kristen J. Nadeau, MD, MS

Kwame Osei, MD

Kevin A. Peterson, MD, MPH, FRCS(Ed),

FAAFP

Jonathan Q. Purnell, MD

Peter Reaven, MD

Ravi Retnakaran, MD, MSc, FRCPC

Helena Wachslicht Rodbard, MD

Elizabeth Seaquist, MD

Guntram Schernthaner, MD

David J. Schneider, MD

Norbert Stefan, MD

Jan S. Ulbrecht, MB, BS

Joseph Wolfsdorf, MD, BCh

Tien Yin Wong, MBBS, FRCSE, FRANZCO,

MPH, PhD

Bernard Zinman, CM, MD, FRCPC, FACP

AMERICAN DIABETES ASSOCIATION OFFICERS

CHAIR OF THE BOARD

Karen Talmadge, PhD

PRESIDENT, MEDICINE & SCIENCE

Jane Reusch, MD

PRESIDENT, HEALTH CARE &

EDUCATION

Felicia Hill-Briggs, PhD, ABPP

SECRETARY/TREASURER

Michael Ching, CPA

CHAIR OF THE BOARD-ELECT

David J. Herrick, MBA

PRESIDENT-ELECT, MEDICINE & SCIENCE

Louis Philipson, MD

PRESIDENT-ELECT, HEALTH CARE &

EDUCATION

Gretchen Youssef, MS, RD, CDE

SECRETARY/TREASURER-ELECT

Brian Bertha, JD, MBA

INTERIM CHIEF EXECUTIVE OFFICER

Martha Parry Clark

CHIEF SCIENTIFIC, MEDICAL & MISSION OFFICER

William T. Cefalu, MD

January 2018Volume 41, Supplement 1

The mission of the American Diabetes Association

is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. AMERICAN DIABETES ASSOCIATION PERSONNEL AND CONTACTS

SENIOR VICE PRESIDENT, PUBLISHER

Michael Eisenstein

ASSOCIATE PUBLISHER,

SCHOLARLY JOURNALS

Christian S. Kohler

EDITORIAL OFFICE DIRECTOR

Lyn Reynolds

PEER REVIEW MANAGER

Shannon Potts

ASSOCIATE MANAGER, PEER REVIEW

Larissa M. Pouch

DIRECTOR, SCHOLARLY JOURNALS

Heather Norton Blackburn

CONTENT PRODUCTION MANAGER

Kelly Newton

EDITORIAL CONTENT MANAGER

Nancy C. Baldino

TECHNICAL EDITOR

Theresa Cooper

DIRECTOR, MEMBERSHIP/SUBSCRIPTION

SERVICES

Donald Crowl

SENIOR ADVERTISING MANAGER

Julie DeVoss Graff

jgraff@diabetes.org (703) 299-5511

ADVERTISING REPRESENTATIVES

American Diabetes Association

Paul Nalbandian

Associate Publisher, Advertising &

Sponsorships

pnalbandian@diabetes.org (703) 549-1500, ext. 4806

Tina Auletta

Senior Account Executive

tauletta@diabetes.org (703) 549-1500, ext. 4809

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The Walchli Tauber Group

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National Sales Manager

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PRINT ISSN 0149-5992

ONLINE ISSN 1935-5548

PRINTED IN THE USA

Diabetes Careis a journal for the health care practitioner that is intended to increase knowledge, stimulate research, and promote better management of people with diabetes. To achieve these goals, the journal publishes original research on human studies in the following categories: Clinical Care/Education/Nutrition/ Psychosocial Research, Epidemiology/Health Services Research, Emerging Technologies and Therapeutics, Pathophysiology/Complications, and Cardiovascular and Metabolic Risk. The journal also publishes ADA statements, consensus reports, of view. Topics covered are of interest to clinically oriented physicians, researchers, epidemiologists, psychologists, diabetes educators, and other health professionals. More information about the journal can be found online at care.diabetesjournals.org. Copyright©2017 by the American Diabetes Association, Inc. All rights reserved. Printed in the USA. Requests for permission to reuse content should be sent to Copyright Clearance Center at www.copyright.com or 222 Rosewood Dr., Danvers, MA 01923; phone: (978)

750-8400; fax: (978) 646-8600. Requests for permission to translate should be sent to

Permissions Editor, American Diabetes Association, at permissions@diabetes.org. The American Diabetes Association reserves the right to reject any advertisement for any reason, which need not be disclosed to the party submitting the advertisement. Commercial reprint orders should be directed to Sheridan Content Services, (800) 635-7181, ext. 8065. Single issues ofDiabetes Carecan be ordered by calling toll-free (800) 232-3472, 8:30 A.M. to 5:00 P.M. EST, Monday through Friday. Outside the United States, call (703) 549-1500. Rates: $75 in the United States, $95 in Canada and Mexico, and $125 for all other countries. Diabetes Careis available online at care.diabetesjournals.org. Please call the numbers listed above, e-mail membership@diabetes.org, or visit the online journal for more information about submitting manuscripts, publication charges, ordering reprints, subscribing to the journal, becoming an ADA member, advertising, permission to reuse content, and the journal's publication policies. Periodicals postage paid at Arlington, VA, and additional mailing ofces.

January 2018Volume 41, Supplement 1

Standards of Medical Care in Diabetes - 2018

S1Introduction

S3Professional Practice Committee

S4Summary of Revisions:Standards of Medical Care in

Diabetes - 2018

S71. Improving Care and Promoting Health inPopulations

Diabetes and Population Health

Tailoring Treatment for Social Context

S132. Classification and Diagnosis of Diabetes

Classication

Diagnostic Tests for Diabetes

Categories of Increased Risk for Diabetes (Prediabetes)

Type 1 Diabetes

Type 2 Diabetes

Gestational Diabetes Mellitus

Monogenic Diabetes Syndromes

Cystic Fibrosis-Related Diabetes

Posttransplantation Diabetes Mellitus

S283. Comprehensive Medical Evaluation andAssessment of Comorbidities

Patient-Centered Collaborative Care

Comprehensive Medical Evaluation

Assessment of Comorbidities

S384. Lifestyle Management

Diabetes Self-Management Education and Support

Nutrition Therapy

Physical Activity

Smoking Cessation: Tobacco and e-Cigarettes

Psychosocial Issues

S515. Prevention or Delay of Type 2 Diabetes

Lifestyle Interventions

Pharmacologic Interventions

Prevention of Cardiovascular Disease

Diabetes Self-management Education and Support

S556. Glycemic Targets

Assessment of Glycemic Control

A1C Testing

A1C Goals

Hypoglycemia

Intercurrent Illness

S657. Obesity Management for the Treatment of Type 2Diabetes

Assessment

Diet, Physical Activity, and Behavioral Therapy

Pharmacotherapy

Metabolic Surgery

S738. Pharmacologic Approaches to Glycemic Treatment

Pharmacologic Therapy for Type 1 Diabetes

Surgical Treatment for Type 1 Diabetes

Pharmacologic Therapy for Type 2 Diabetes

S869. Cardiovascular Disease and RiskManagement

Hypertension/Blood Pressure Control

Lipid Management

Antiplatelet Agents

Coronary Heart Disease

S10510. Microvascular Complications and Foot Care

Diabetic Kidney Disease

Diabetic Retinopathy

Neuropathy

Foot Care

S11911. Older Adults

Neurocognitive Function

Hypoglycemia

Treatment Goals

Pharmacologic Therapy

Treatment in Skilled Nursing Facilities

and Nursing Homes

End-of-Life Care

S12612. Children and Adolescents

Type 1 Diabetes

Type 2 Diabetes

Transition From Pediatric to Adult Care

S13713. Management of Diabetes in Pregnancy

Diabetes in Pregnancy

Preconception Counseling

Glycemic Targets in Pregnancy

Management of Gestational Diabetes Mellitus

Management of Preexisting Type 1 Diabetes

and Type 2 Diabetes in Pregnancy

Pregnancy and Drug Considerations

Postpartum Care

S14414. Diabetes Care in the Hospital

Hospital Care Delivery Standards

Glycemic Targets in Hospitalized Patients

Bedside Blood Glucose Monitoring

Antihyperglycemic Agents in Hospitalized Patients

Hypoglycemia

Medical Nutrition Therapy in the Hospital

Self-management in the Hospital

Standards for Special Situations

Transition From the Acute Care Setting

Preventing Admissions and Readmissions

S15215. Diabetes Advocacy

Advocacy Position Statements

S154Professional Practice Committee, American College ofCardiology - Designated Representatives, and

American Diabetes Association Staff Disclosures

S156Index

This issue is freely accessible online at care.diabetesjournals.org.

Keep up with the latest information forDiabetes Careand other ADA titles via Facebook (/ADAJournals) and Twitter (@ADA_Journals).

Professional Practice Committee:

Standards of Medical Care in Diabetesd2018

Diabetes Care 2018;41(Suppl. 1):S3|https://doi.org/10.2337/dc18-SPPC01

The Professional Practice Committee

(PPC) of the American Diabetes Asso- ciation (ADA) is responsible for the "Standards of Medical Care in Diabetes" position statement, referred to as the

StandardsofCare.ThePPCisamultidis-

ciplinary expert committee comprised ofphysicians,diabeteseducators,regis- tered dietitians, and others who have expertise in a range of areas, including adult and pediatric endocrinology, epi- demiology,publichealth,lipidresearch, hypertension, preconception planning, and pregnancy care. Appointment to thePPCisbasedonexcellenceinclinical practice andresearch.Althoughthe pri- mary role of the PPC is to review and update the Standards of Care, it may also be involved in ADA statements, re- ports, and reviews.

The ADA adheres to the National

AcademyofMedicineStandardsforDe-

veloping Trustworthy Clinical Practice

Guidelines. All members of the PPC

are required to disclose potential con- icts of interest with industry and/or other relevantorganizations.Thesedis- closures are discussed at the onset of each Standards of Care revision meet- ing. Members of the committee, their employers, and their disclosed conicts ofinterestarelistedinthe"Professional Practice Committee Disclosures"table(see pp. S154-S155). The ADA funds de- velopmentoftheStandardsofCareoutof its general revenues and does not use in- dustry support for this purpose.

For the current revision, PPC members

systematically searched MEDLINE for hu- man studies related to each section and published since 1 January 2017. Recom- mendations were revised based on new evidence or, in some cases, to clarify the prior recommendation or match the strength of the wording to the strength of the evidence. A table linking the changes in recommendations to new ev- idence can be reviewed at professional .diabetes.org/SOC. The Standards of Care wasapprovedbyADA'sBoardofDirectors, which includes health care professionals, scientists, and lay people.

Feedback from the larger clinical com-

munity was valuable for the 2017 revision of the Standards of Care. Readers who wish to comment on the 2018 Standards ofCareareinvited to doso atprofessional .diabetes.org/SOC.

ThePPCwouldliketothankthefollow-

ing individuals who provided their exper- tise in reviewing and/or consulting with thecommittee:PamelaAllweiss,MD,MPH;

David D"Alessio, MD; Thomas Gardner,

MD, MS; William H. Herman, MD, MPH;

Felicia Hill-Briggs, PhD; Nisa Maruthur,

MD, MHS; Alicia McAuliffe-Fogarty, PhD,CPsychol; Jane Reusch, MD; and Sharon

Solomon, MD.

MEMBERS OF THE PPC

Rita R. Kalyani, MD, MHS, FACP (Chair)

Christopher P. Cannon, MD

Andrea L. Cherrington, MD, MPH*

Donald R. Coustan, MD

Ian H. de Boer, MD, MS*

Hope Feldman, CRNP, FNP-BC

Judith Fradkin, MD

David Maahs, MD, PhD

Melinda Maryniuk, MEd, RD, CDE

Medha N. Munshi, MD*

Joshua J. Neumiller, PharmD, CDE, FASCP

GuillermoE.Umpierrez,MD,CDE,FACE,FACP*

*Subgroup leaders

AMERICAN COLLEGE OF

CARDIOLOGY—DESIGNATED

REPRESENTATIVES (SECTION 9)

Sandeep Das, MD, MPH, FACC

Mikhail Kosiborod, MD, FACC

ADA STAFF

Erika Gebel Berg, PhD

(Corresponding author: eberg@diabetes.org)

Tamara Darsow, PhD

Matthew P. Petersen

Sacha Uelmen, RDN, CDE

William T. Cefalu, MD

© 2017 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for prot,

and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.

Diabetes CareVolume 41, Supplement 1, January 2018S3

PROFESSIONAL PRACTICE COMMITTEE

Introduction:Standards of Medical

Care in Diabetesd2018

Diabetes Care 2018;41(Suppl. 1):S1-S2|https://doi.org/10.2337/dc18-SINT01

Diabetes is a complex, chronic illness re-

quiring continuous medical care with mul- tifactorial 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 compli- cations. Signicant evidence exists that supports a range of interventions to im- prove diabetes outcomes.

The American Diabetes Association"s

(ADA"s)“Standards of Medical Care in

Diabetes,"referred to as the Standards

of Care, is intended to provide clinicians, patients, researchers, payers, and otherquotesdbs_dbs22.pdfusesText_28