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ExecutiveSummary

ExecutiveSummary:StandardsofMedicalCareinDiabetes—2008

hesestandardsofcareareintendedtoprovideclinicians,patients,re-searchers,payors,andotherinter-estedindividualswiththecomponentsofdiabetescare,treatmentgoals,andtoolstoevaluatethequalityofcare.Whilein-dividualpreferences,comorbidities,andotherpatientfactorsmayrequiremodi -cationofgoals,targetsthataredesirableformostpatientswithdiabetesarepro-vided.Thesestandardsarenotintendedtoprecludemoreextensiveevaluationandmanagementofthepatientbyotherspecialistsasneeded.

Therecommendationsincludedarescreening,diagnostic,andtherapeuticac-tionsthatareknownorbelievedtofavor-ablyaffecthealthoutcomesofpatientswithdiabetes.Agradingsystemdevel-opedbytheAmericanDiabetesAssocia-tionandmodeledafterexistingmethodswasutilizedtoclarifyandcodifytheevi-dencethatformsthebasisfortherecom-mendations.Thelevelofevidencethatsupportseachrecommendationislistedaftereachrecommendationusingthelet-tersA,B,C,orE.

Formoredetailedinformation,refertothefulldocument:“StandardsofMed-icalCareinDiabetes—2008.”TOPICAREASANDRECOMMENDATIONS

DiagnosisofDiabetes

●Thefastingplasmaglucose(FPG)textisthepreferredtesttodiagnosediabetesinchildrenandnonpregnantadults.(E)●UseoftheA1Cforthediagnosisofdi-abetesisnotrecommendedatthistime.(E)

T

TestingforPre-diabetesandDiabetes

●Testingtodetectpre-diabetesandtype2diabetesinasymptomaticpeopleshouldbeconsideredinadultswhoareoverweightorobese(BMI 25kg/m2)andwhohaveonemoremoreaddi-tionalriskfactorsfordiabetes.Inthosewithouttheseriskfactors,testingshouldbeginatage45.(B)

●Iftestsarenormal,repeattestingshouldbecarriedoutatleastat3-yearinter-vals.(E)

●Totestforpre-diabetesordiabetes,ei-theranFPGtestor2-horalglucosetol-erancetest(OGTT;75-gglucoseload),orboth,isappropriate.(B)

●AnOGTTmaybeconsideredinpa-tientswithimpairedfastingglucose(IFG)tobetterde netheriskofdiabe-tes.(E)

●Inthoseidenti edwithpre-diabetes,identifyand,ifappropriate,treatotherCVDriskfactors.(B)

TestingforType2DiabetesinChildren

●Testchildrenwhoareoverweight(BMI 85thpercentileforageandsex,weightforheight 85thpercentile,orweight 120%ofidealforheight)andhavetwoofthefollowingriskfactors:●Familyhistoryoftype2diabetesin rst-orsecond-degreerelative

●Race/ethnicity(NativeAmerican,Af-ricanAmerican,Latino,AsianAmer-ican,Paci cIslander)

●Signsofinsulinresistanceorcondi-tionsassociatedwithinsulinresistance(acanthosisnigricans,hypertension,dyslipidemia,orpolycysticovarysyn-drome[PCOS])

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Maternalhistoryofdiabetesorgesta-tionaldiabetesmellitus(GDM)(E)Testingshouldbeginatage10yearsoratonsetofpuberty,ifpubertyoccursatayoungerage,andberepeatedevery2years.(E)

TheFPGisthepreferredtest.(E)

DetectionandDiagnosisofGDM●ScreenforGDMusingriskfactoranal-ysisand,ifappropriate,useofanOGTT.(C)

●WomenwithGDMshouldbescreenedfordiabetes6–12weekspostpartumandshouldbefollowedupwithsubse-quentscreeningforthedevelopmentofdiabetesorpre-diabetes.(E)

Prevention/DelayofType2Diabetes●Patientswithimpairedglucosetoler-ance(IGT)(A)orIFG(E)shouldbegivencounselingonweightlossof5–10%ofbodyweight,aswellasonincreasingphysicalactivitytoatleast150minperweekofmoderateactivitysuchaswalking.

●Follow-upcounselingappearstobeim-portantforsuccess.(B)

●Basedonpotentialcostsavingsofdia-betesprevention,suchcounselingshouldbecoveredbythird-partypay-ors.(E)

●Inadditiontolifestylecounseling,met-forminmaybeconsideredinthosewhoareatveryhighrisk(combinedIFGandIGTplusotherriskfactors)andwhoareobeseandunder60yearsofage.(E)●Monitoringforthedevelopmentofdi-abetesinthosewithpre-diabetesshouldbeperformedeveryyear.(E)Self-monitoringofBloodGlucose(SMBG)

●SMBGshouldbecarriedoutthreeormoretimesdailyforpatientsusingmul-tipleinsulininjectionsorinsulinpumptherapy.(A)

●Forpatientsusinglessfrequentinsulininjections,noninsulintherapies,ormedicalnutritiontherapy(MNT)alone,SMBGmaybeusefulinachiev-ingglycemicgoals.(E)

●Toachievepostprandialglucosetar-S5

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Abbreviations:ABI,ankle-brachialindex;ADA,AmericanDiabetesAssociation;ARB,angiotensisrecep-torblocker;CBG,capillarybloodglucose;CHD,Coronaryheartdisease;CKD,chronickidneydisease;CVD,cardiovasculardisease;DMMP,diabetesmedicalmanagementplan;DPN,distalsymmetricpolyneuropathy;DSME,diabetesself-managementeducation;FPG,fastingplasmaglucose;GDM,gestationaldiabetesmel-litus;GFR,glomerular ltrationrate;IFG,impairedfastingglucose;IGT,impairedglucosetolerance;MNT,medicalnutritiontherapy;NPDR,proliferativediabeticretinopathy;OGTT,oralglucosetolerancetest;PAD,peripheralarterialdisease;PDR,proliferativediabeticretinopathy;SMBG,self-monitoringofbloodglucose;TSH,thryoid-stimulatinghormone.DOI:10.2337/dc08–S005.

©2008bytheAmericanDiabetesAssociation.

DIABETESCARE,VOLUME31,SUPPLEMENT1,JANUARY2008