[PDF] AMERICAN DIABETES ASSOCIATION STANDARDS OF MEDICAL CARE IN

AMERICAN DIABETES ASSOCIATION STANDARDS OF MEDICAL CARE IN

Jan 01, 2016 · Standards of Medical Care in Diabetes—2017 S1 Introduction S3 Professional Practice Committee S4 Standards of Medical Care in Diabetes—2017: Summary of Revisions S6 1 Promoting Health and Reducing Disparities in Populations Diabetes and Population Health Tailoring Treatment to Reduce Disparities S11 2 Classification and Diagnosis of Diabetes

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Dec 21, 2015 · “Standards of Medical Care in Diabetes” Standards of Care: ADA position state-ment that provides key clinical practice recommendations ThePPCperformsan extensive literature search and updates the Standards annually based on the quality of new evidence ADA Position Statement A position statement is an official ADA

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Jan 01, 2017 · (ADA’s) “Standards of Medical Care in Diabetes,” referred to as the Standards of Care, is intended to provide clinicians, patients, researchers, payers, and other interested individuals with the compo-nentsofdiabetescare,generaltreatment goals,andtoolstoevaluatethequalityof care The Standards of Care recommen

American Diabetes Association Standards of Medical Care in

American Diabetes Association Standards of Medical Care in Diabetes –2018 Diabetes Care 2018;41(Suppl 1) Summary • ADA Standards of Care provide comprehensive, evidence-based recommendations for the management of diabetes • Standards continue to focus on individualization of therapy for both glycemic control and comorbidities of diabetes

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Outline ADA diagnostic criteria for Diabetes and Pre-Diabetes Review Goals of Care from Standards of Medical Care in Diabetes 2020 from the ADA Glucometer vs Continuous Glucose Monitoring (CGM) Review pharmacologic recommendations of glycemic treatment for type 2 diabetes Review Other Maintenance Care for Diabetes 1 Type of DM 2

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ISSN 0149-5992

THE JOURNAL OF CLINICAL AND APPLIED RESEARCH AND EDUCATION WWW.DIABETES.ORG/DIABETESCARE JANUARY 2018VOLUME 41 | SUPPLEMENT 1

AMERICAN DIABETES ASSOCIATION

STANDARDS OFMEDICAL CAREIN DIABETES"2018S

U P P L E M E N T 1

American DiabetesAssociation

Standards of

Medical Carein

Diabetes

d2018 [T]he simpleword Caremay sufce toex press[thejournal"s] philosophical mission.The newjou rnalis designedtoprom otebetter patientcare by serving theexpande dneedsofall healthprofe ssionals committed tothe care of patientswith diabetes.Assuch,the American Diabetes Association views DiabetesCare as areaf rmationof Francis WeldPeabody"s contentionthat “the secretof thecare ofthe patient isin caringfo rthepatient. " —Norbert Freinkel,Diabetes Care, January-February1978

EDITOR INCHIEF

Matthew C.Riddle, MD

ASSOCIATE EDITORS

George Bakris,MD

Lawrence Blonde,MD, FACP

Andrew J.M.Boulton, MD

David D"Alessio, MD

Mary deGroot, 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. HansDeVries, 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. SueKirkman, MD

Ildiko Lingvay,MD, MPH,MSCS

Harold DavidMcIntyre, MD,FRACP Maureen Monaghan,PhD, CDEKristen 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 WachslichtRodbard, MD

Elizabeth Seaquist,MD

Guntram Schernthaner,MD

David J.Schneider, MD

Norbert Stefan,MD

Jan S.Ulbrecht, MB,BS

Joseph Wolfsdorf,MD, BCh

Tien YinWong, MBBS,FRCSE, FRANZCO,

MPH, PhD

Bernard Zinman,CM, MD,FRCPC, FACP

AMERICAN DIABETESASSOCIATIO NOFFICERS

CHAIR OFTHE BOARD

Karen Talmadge,PhD

PRESIDENT, MEDICINE&SCIE NCE

Jane Reusch,MD

PRESIDENT, HEALTHCARE &

EDUCATION

Felicia Hill-Briggs,PhD, ABPP

SECRETARY/TREASURER

Michael Ching,CPA

CHAIR OFTHE BOARD-ELECT

David J.Herrick, MBA

PRESIDENT-ELECT,MEDI CINE&SCIENCE

Louis Philipson,MD

PRESIDENT-ELECT,HEALTH CARE&

EDUCATION

Gretchen Youssef,MS, RD,CDE

SECRETARY/TREASURER-ELECT

Brian Bertha,JD, MBA

INTERIM CHIEFEX ECUTIVEOFFICER

Martha ParryClark

CHIEFS CIENTIFIC,MEDICAL&MISSIONOFF ICER

William T.Cefalu, MD

January 2018Volume 41,Supplement 1

The missionof theAmerican DiabetesAssociation

is toprevent andcure diabetesand toimprove the livesof allpeople affectedby diabetes. AMERICAN DIABETESASSOCIATIO NPERSONNELAND CONTACTS

SENIOR VICEPRES IDENT,PUBLISHER

Michael Eisenstein

ASSOCIATEP UBLISHER,

SCHOLARLY JOURNALS

Christian S.Kohler

EDITORIAL OFFICEDIRECTOR

Lyn Reynolds

PEER REVIEWMANAGER

Shannon Potts

ASSOCIATE MANAGER,PEERREVIEW

Larissa M.Pouch

DIRECTOR, SCHOLARLYJOURNAL S

Heather NortonBlackburn

CONTENT PRODUCTIONMANAGER

Kelly Newton

EDITORIAL CONTENTMANAGER

Nancy C.Baldino

TECHNICAL EDITOR

Theresa Cooper

DIRECTOR, MEMBERSHIP/SUBSCRIPTION

SERVICES

Donald Crowl

SENIOR ADVERTISINGMANAGER

Julie DeVossGraff

jgraff@diabetes.org (703) 299-5511

ADVERTISINGREP RESENTATIVES

American DiabetesAssociation

Paul Nalbandian

Associate Publisher,Advertising &

Sponsorships

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

Tina Auletta

Senior AccountExecutive

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

PHARMACEUTICAL/DEVICEDIGITAL ADVERTISING

The WalchliTauber Group

Maura Paoletti

National SalesManager

maura.paoletti@wt-group.com (443) 512-8899,ext. 110

PRINT ISSN0149-5992

ONLINE ISSN1935-5548

PRINTED INTHE USA

Diabetes Careis ajournal forthe healthcare practitionerthat isintended to increase knowledge,stimulate research,and promotebetter managementof people with diabetes.To achievethese goals,the journalpublishes originalresearch on humanstu diesinthefollow ing categor ies:ClinicalCare/Edu cation/Nutrition/ PsychosocialResearch, Epidemiology/Healt hServicesResearch,Emerging TechnologiesandTherape utics,Pa thophysiology/Complication s,andCardiovascular andMe tabolicRisk.Thejo urnalalso publishe sADAstatements ,consensus reports, ofvi ew.Topics coveredareofin teresttoclinic allyorie nted physicians,rese arc hers, epidemiologists,psychologists, diabeteseducators,andot herhealthprofessi onals. Moreinf ormationaboutthejourna lcanbef oundonli neatcare.diabet esjourn als.org. Copyright©2017 bythe AmericanDiabetes Association,Inc. Allrights reserved.Printed in the USA.Requests forpermission toreuse contentshould besent toCopyright Clearance Center atwww.copyright.com or222 RosewoodDr., Danvers,MA 01923;phone: (978)

750-8400; fax:(978) 646-8600.Requests forpermission totranslate shouldbe sentto

Permissions Editor,American DiabetesAssociation, atpermissions@diabetes.org. The AmericanDiabetes Associationreserves theright toreject anyadvert isementfor any reason,which neednot bedisclosed tothe partysubmitting theadvertisement. Commercial reprintorders shouldbe directedto SheridanContent Services, (800) 635-7181,ext. 8065. Single issuesof Diabetes Carecan beordered bycalling toll-free(800) 232-3472,8:30 A.M. to 5:00P.M. EST,Monday throughFriday. Outsidethe UnitedStates, call(703) 549-1500. Rates: $75in theUnited States,$95 inCanada andMexico, and$125 forall othercountries. Diabetes Careis availableonline atcare.diabetesjournals.org. Pleasecall the numbers listedabove, e-mailmembership@diabetes.org, orvisit theonline journalfor more informationabout submittingmanuscripts, publicationcharges, orderingreprints, subscribing tothe journal,becoming anADA member,advertising, permissionto reuse content, andthe journal's publicationpolicies. Periodicals postagepaid atArlington, VA,and additionalmailing ofces.

January 2018Volume 41,Supplement 1

Standards ofMedical Carein Diabetes—2018

S1Introduction

S3Professional PracticeCommittee

S4Summary ofRevisions: Standards ofMedical Carein

Diabetes - 2018

S71. ImprovingCare andPromoting Healthin Populations

Diabetes andPopulation Health

Tailoring Treatmentfor SocialContext

S132. Classication andDiagnosis ofDiabetes

Classication

Diagnostic Testsfor Diabetes

Categories ofIncreased Risk forDiabetes( Prediabetes)

Type 1Diabetes

Type 2Diabetes

Gestational DiabetesMellitus

MonogenicDiabetes Syndromes

Cystic Fibrosis-Related Diabetes

PosttransplantationDiabetes Mellitus

S283. ComprehensiveMedical Evaluationand Assessment ofComorbidities

Patient-CenteredCollaborative Care

ComprehensiveMedical Evaluation

Assessment ofComorbidities

S384. LifestyleManagement

Diabetes Self-ManagementEducation andSupport

Nutrition Therapy

PhysicalActivity

Smoking Cessation:Tobacco ande-Cigarettes

Psychosocial Issues

S515. Preventionor Delayof Type2 Diabetes

Lifestyle Interventions

PharmacologicInterventions

Prevention ofCardiovascular Disease

Diabetes Self-managementEducation andSupport

S556. GlycemicTargets

Assessment ofGlycemic Control

A1C Testing

A1C Goals

Hypoglycemia

Intercurrent Illness

S657. ObesityManage mentfortheTreatment ofType2 Diabetes

Assessment

Diet, PhysicalActivity, andBehavioral Therapy

Pharmacotherapy

Metabolic Surgery

S738.Phar macologicApproachesto GlycemicTreatment

PharmacologicTherapy forType 1Diabetes

Surgical Treatmentfor Type1 Diabetes

PharmacologicTherapy forType 2Diabetes

S869. CardiovascularDisease andRisk Management

Hypertension/Blood PressureControl

Lipid Management

Antiplatelet Agents

Coronary HeartDisease

S10510. MicrovascularComplications andFoot Care

Diabetic KidneyDisease

Diabetic Retinopathy

Neuropathy

Foot Care

S11911. OlderAdults

Neurocognitive Function

Hypoglycemia

Treatment Goals

Pharmacologic Therapy

Treatment inSkilled NursingFacilities

and NursingHomes

End-of-Life Care

S12612. Childrenand Adolescents

Type 1Diabetes

Type 2Diabetes

Transition FromPediatric toAdult Care

S13713. Managementof Diabetesin Pregnancy

Diabetes inPregnancy

Preconception Counseling

Glycemic Targetsin Pregnancy

Management ofGestational DiabetesMellitus

Management ofPreexisting Type1 Diabetes

and Type2 Diabetesin Pregnancy

Pregnancy andDrug Considerations

Postpartum Care

S14414. DiabetesCare inthe Hospital

Hospital CareDelivery Standards

Glycemic Targetsin HospitalizedPatients

Bedside BloodGlucose Monitoring

Antihyperglycemic Agentsin HospitalizedPatients

Hypoglycemia

Medical NutritionTherapy inthe Hospital

Self-management inthe Hospital

Standards forSpecial Situations

Transition Fromthe AcuteCare Setting

Preventing Admissionsand Readmissions

S15215. DiabetesAdvocacy

Advocacy PositionStatements

S154Professional PracticeCommittee, AmericanCollege ofCardiology - Designated Representatives,and

American DiabetesAssociation StaffDisclosures

S156Index

This issueis freelyaccessible onlineat care.diabetesjourna ls.org.

Keep upwith thelatest informationfor Diabetes Careand otherADA titlesvia Facebook(/ADAJourn als)and Twitter(@ADA_Journ als).

Introduction:Standards ofMedical

Care inDiabetes d2018

DiabetesCare20 18;41(Suppl .1):S1-S2|https://doi.org/10.2337/dc18-SINT01

Diabetes isa complex, chronicillness re-

quiringcon tinuousmedicalcarewithmul- tifactorialrisk-reductionstrategiesb eyond glycemicco ntrol.Ongoingpatient self- management educationa ndsupportare criticalto preventing acutec omplications andr educingtheriskof long-ter mc ompli- cations.Signi cant evidenceexists that supportsa range ofinterventionstoim- prove diabetesout comes.

The AmericanDiabetes Association's

(ADA's)"Standardsof MedicalCarein

Diabetes,"referredtoasthe Standa rds

of Care,isinte nded toprovideclini cia ns, patients,research ers,payers,andother interestedindivid ualswiththecom po- nentsofdiabetescare,generaltreatment goals,andto olstoev aluatethe qua lityof care.The Standar dsofCarerecommen- dationsarenotintendedtoprecludeclin- icaljud gmentandmustbeapp liedint he context ofex cellentclinicalcare,with adjustments forindividual preferences, comorbidities,andotherpati entfact ors.

For moredetailedi nformationabout

managementofdiabetes, ple asereferto

MedicalManagem entofType1Diabetes

(1)a ndMedicalManagem entofType2

Diabetes(2).

The recommendationsinclude screen-

ing,diag nostic,andtherapeutic action s thatare known orbelieved tofavorably affect healthoutcomes ofp atientsw ithdi- abetes. Manyoft heseinterventions have also beenshownt ob ecost-effective( 3).

The ADAstrives toimprove andupdate

the Standardsof Caretoe nsurethatclin i- cians, healthplans,an dpolicy makerscancontinuetorely onthem asthe most au- thoritativea ndcurrentguidelines ford ia- betescare.Readerswhowishtocomment on the2 018Standardso fCarea reinvited todosoatprofessional.diabetes.org/SOC.

ADAST ANDARDS,STATEMENTS,

REPORTS,andREVI EWS

The ADAhas beenac tivelyinvolvedinthe

developmentandd isseminationofdiabe- tes carestan dards,guidelines,andre lated documents forover 25 years.The ADA's clinical practicerecommendations are viewedas importa ntresourcesforheal th care professionalswhocare forpeople withdia betes.

StandardsofCare

ThisdocumentisanofcialADAposition,

is authoredbytheADA, and provides all of theADA 's currentclinical practicerec- ommendations.ToupdatetheSt andards of Care,theAD A's ProfessionalPractice

Committee(PPC)perf ormsanextens ive

clinicaldiabetes literaturesearch,supple- mentedwithinputfromADAstaffandthe medicalcommunityatlarge.ThePPCup- dates theStandar dsofCareannuall y,o r morefre quentlyonlineshouldthePPC determinethat ne wevidenceorregula- torych anges(e.g.,drug approvals,l abel changes)merit immediate incor poration.

The StandardsofCare supersedes all pre-

vious ADAposition stateme ntsdandt he recommendations therein d on clinical topicswith inthepurvie wofthe Stand- ards ofCare; ADApositio nstatem ents, while stillcontaining valuableanalyses, shouldnot beconsidered theADA'scurrentpositio n.TheStandardsof Care receivesannualre viewandappr ovalby theAD ABoard ofDirectors .

ADASt atement

An ADAstatement isan of

cialADAp oin t ofview orbelief thatdoes notcontain clin- icalpracticerecommendationsandmaybe issued onadvocacy, policy,econom ic,or medical issuesrelated todiabetes. ADA statements undergoa formalreview pro- cess,in cludingareviewbythe appropriate nationalcommittee, ADAm issionstaff, and the BoardofDirectors.

ConsensusReport

An expertconsens usreportofapartic u-

lar topicconta insacomprehensi veex - aminationandisau thoredby anex pert panel(i.e .,consensuspa nel)andrepre- sentsthepanel'scollectiveanalysis,eval- uation,a ndopinion. Then eedforanquotesdbs_dbs5.pdfusesText_9