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Standards of Medical Care for Patients With Diabetes Mellitus

Originally approved 1988. Most recent review/revision, October 2002. Abridged from Diabetes Care 26 (Suppl. 1):S33–S50, 2003.

The first 300 words of the full text of this article appear below.

Editor’s note: This is an abridged reprint. Full text of this position statement and accompanying references are available on the American Diabetes Association website at http://care.diabetesjournals.org/cgi/content/full/26/suppl_1/s33.

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 persons 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 Skyler (Ed.): Medical Management of Type 1 Diabetes¹ and Zimmerman (Ed.): Medical Management of Type 2 Diabetes.²

The recommendations included are 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.

Classification
In 1997, the ADA issued new diagnostic and classification criteria.³ The classification of diabetes mellitus includes four clinical classes:

• Type 1 diabetes (results from ß-cell destruction, usually leading to absolute insulin deficiency).
  
• Type . . . [Full Text of this Article]

Glycemic control
Referral for diabetes management
Recommendations
ASSESSMENT OF GLYCEMIC CONTROL

Self-monitoring of blood glucose
Recommendations
A1C

Recommendations
MEDICAL NUTRITION THERAPY

Recommendations
PHYSICAL ACTIVITY

Recommendations
PREVENTION AND MANAGEMENT OF DIABETES COMPLICATIONS

I. CVD: management of risk factors and screening for coronary artery disease
A. Blood pressure control
Recommendations
Screening and diagnosis
Goals
Treatment
B. Lipid management
Recommendations
General recommendations
Goals
Screening
Treatment
C. Anti-platelet therapy in diabetes
Recommendations
D. Smoking Cessation
Recommendations
E. CHD screening and treatment
Recommendations
II. Nephropathy screening and treatment
Recommendations
General recommendations
Screening
Treatment
III. Diabetic retinopathy screening and treatment
Recommendations
General Recommendations
Screening
Treatment
IV. Foot care
Recommendations
PREVENTIVE CARE

I. Preconception care
Recommendations
II. Immunization
Recommendations
SPECIAL CONSIDERATIONS

I. Care of older adults with diabetes
II. Children and adolescents

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