Standards of Medical Care in Diabetes—2015

January 2015 Volume 38, Supplement 1 Standards of Medical Care in Diabetes—2015 S1 Introduction S49 8. Cardiovascular Disease and Risk Management S3 Professional Practice Committee Hypertension/Blood Pressure Control S4 Standards of Medical Care in Diabetes—2015: Dyslipidemia/Lipid Management Summary of Revisions Antiplatelet Agents Coronary Heart Disease S5 1. Strategies for Improving Care S58 9. Microvascular Complications and Foot Care Diabetes Care Concepts Care Delivery Systems Nephropathy When Treatment Goals Are Not Met Retinopathy Neuropathy S8 2. Classification and Diagnosis of Diabetes Foot Care Classification S67 10. Older Adults Diagnostic Tests for Diabetes Categories of Increased Risk for Diabetes Treatment Goals (Prediabetes) Hypoglycemia Type 1 Diabetes Pharmacological Therapy Type 2 Diabetes S70 11. Children and Adolescents Gestational Diabetes Mellitus Monogenic Diabetes Syndromes Type 1 Diabetes Cystic Fibrosis–Related Diabetes Type 2 Diabetes S17 3. Initial Evaluation and Diabetes Management Psychosocial Issues Planning S77 12. Management of Diabetes in Pregnancy Medical Evaluation Diabetes in Pregnancy Management Plan Preconception Counseling Common Comorbid Conditions Glycemic Targets in Pregnancy S20 4. Foundations of Care: Education, Nutrition, Pregnancy and Antihypertensive Drugs Physical Activity, Smoking Cessation, Management of Gestational Diabetes Mellitus Psychosocial Care, and Immunization Management of Pregestational Type 1 Diabetes and Type 2 Diabetes in Pregnancy Diabetes Self-management Education and Support Postpartum Care Medical Nutrition Therapy Physical Activity S80 13. Diabetes Care in the Hospital, Nursing Home, Smoking Cessation and Skilled Nursing Facility Psychosocial Assessment and Care Hyperglycemia in the Hospital Immunization Glycemic Targets in Hospitalized Patients S31 5. Prevention or Delay of Type 2 Diabetes Antihyperglycemic Agents in Hospitalized Patients Preventing Hypoglycemia Lifestyle Modifications Diabetes Care Providers in the Hospital Pharmacological Interventions Self-management in the Hospital Diabetes Self-management Education and Support Medical Nutrition Therapy in the Hospital S33 6. Glycemic Targets Bedside Blood Glucose Monitoring Discharge Planning Assessment of Glycemic Control Diabetes Self-management Education A1C Goals Hypoglycemia S86 14. Diabetes Advocacy Intercurrent Illness Advocacy Position Statements S41 7. Approaches to Glycemic Treatment S88 Professional Practice Committee for the Standards Pharmacological Therapy for Type 1 Diabetes of Medical Care in Diabetes—2015 Pharmacological Therapy for Type 2 Diabetes Bariatric Surgery S90 Index This issue is freely accessible online at care.diabetesjournals.org. Keep up with the latest information for Diabetes Care and other ADA titles via Facebook (/ADAJournals) and Twitter (@ADA_Journals). Diabetes Care Volume 38, Supplement 1, January 2015 S1 INTRODUCTION Introduction Diabetes Care 2015;38(Suppl. 1):S1–S2 | DOI: 10.2337/dc15-S001 Diabetes is a complex, chronic illness re- ADA STANDARDS, STATEMENTS, ADA Scientific Statement quiring continuous medical care with AND REPORTS A scientific statement is an official multifactorial risk-reduction strategies The ADA has been actively involved in ADA point of view or belief that may or beyond glycemic control. Ongoing pa- the development and dissemination of may not contain clinical or research rec- tient self-management education and diabetes care standards, guidelines, and ommendations. Scientificstatements support are critical to preventing acute related documents for over 20 years. contain scholarly synopsis of a topic re- complications and reducing the risk of ADA’s clinical practice recommenda- lated to diabetes. Workgroup reports long-term complications. Significant tions are viewed as important resources fall into this category. Scientific state- evidence exists that supports a range for health care professionals who care ments are published in the ADA journals of interventions to improve diabetes for people with diabetes. ADA’s “Stan- and other scientific/medical publications, outcomes. dards of Medical Care in Diabetes,” as appropriate. Scientific statements also The American Diabetes Association’s position statements, and scientific undergo a formal review process. (ADA’s) “Standards of Medical Care in statements undergo a formal review Diabetes” is intended to provide cli- process by ADA’s Professional Practice Consensus Report nicians, patients, researchers, payers, Committee (PPC) and the Executive A consensus report contains a compre- and other interested individuals with Committee of the Board of Directors. hensive examination by an expert panel the components of diabetes care, gen- The Standards and all ADA position state- (i.e., consensus panel) of a scientificor eral treatment goals, and tools to eval- ments, scientific statements, and consensus medical issue related to diabetes. A con- uate the quality of care. The Standards reports are available on the Association’s sensus report is not an ADA position and of Care recommendations are not in- Web site at http://professional.diabetes.org/ represents expert opinion only. The cat- tended to preclude clinical judgment adastatements. egory may also include task force and and must be applied in the context of expert committee reports. The need excellent clinical care, with adjustments “Standards of Medical Care in Diabetes” for a consensus report arises when clini- for individual preferences, comorbid- Standards of Care: ADA position state- cians or scientists desire guidance on ities, and other patient factors. For ment that provides key clinical practice a subject for which the evidence is con- more detailed information about man- recommendations. The PPC performs an tradictory or incomplete. A consensus agement of diabetes, please refer to extensive literature search and updates report is typically developed immedi- Medical Management of Type 1 Diabetes the Standards annually based on the ately following a consensus conference (1) and Medical Management of Type 2 quality of new evidence. where the controversial issue is exten- Diabetes (2). sively discussed. The report represents The recommendations include screen- ADA Position Statement the panel’s collective analysis, evalua- ing, diagnostic, and therapeutic actions A position statement is an official ADA tion, and opinion at that point in time that are known or believed to favor- point of view or belief that contains clinical based in part on the conference pro- ably affect health outcomes of patients or research recommendations. Position ceedings. A consensus report does not with diabetes. Many of these interven- statements are issued on scientificormed- undergo a formal ADA review process. tionshavealsobeenshowntobecost- ical issues related to diabetes. They are effective (3). published in ADA journals and other scien- GRADING OF SCIENTIFIC EVIDENCE The ADA strives to improve and update tific/medical publications. ADA position Since the ADA first began publishing the Standards of Care to ensure that clini- statements are typically based on a sys- practice guidelines, there has been con- cians, health plans, and policy makers can tematic review or other review of pub- siderable evolution in the evaluation of continue to rely on them as the most au- lished literature. Position statements scientific evidence and in the develop- thoritative and current guidelines for di- undergo a formal review process. They ment of evidence-based guidelines. abetes care. are updated annually or as needed. In 2002, we developed a classification “Standards of Medical Care in Diabetes” was originally approved in 1988. Most recent review/revision: October 2014. © 2015 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 profit, and the work is not altered. S2 Introduction Diabetes Care Volume 38, Supplement 1, January 2015 Table 1—ADA evidence-grading system for “Standards of Medical Care in Diabetes” recommendations have the best chance Level of of improving outcomes when applied to evidence Description the population to which they are appropriate. Recommendations with lower A Clear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered, including levels of evidence may be equally impor- c Evidence from a well-conducted multicenter trial tant but are not as well supported. c Evidence from a meta-analysis that incorporated quality ratings in the Of course, evidence is only one com- analysis ponent of clinical decision making. Clini- Compelling nonexperimental evidence; i.e., “all or none” rule developed by cians care for patients, not populations; the Centre for Evidence-Based Medicine at the University of Oxford guidelines must always be interpreted Supportive evidence from well-conducted randomized controlled trials that with the individual patient in mind. are adequately powered, including c Evidence from a well-conducted trial at one or more institutions Individual circumstances, such as co- c Evidence from a meta-analysis that incorporated quality ratings in the morbid and coexisting diseases, age, ed- analysis ucation, disability, and, above all, B Supportive evidence from well-conducted cohort studies patients’ values and preferences, must c Evidence from a well-conducted prospective cohort study or registry be considered and may lead to different c Evidence from a well-conducted meta-analysis of cohort studies treatment targets and

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