Standards of Medical Care for Patients With Diabetes Mellitus
- American Diabetes Association
Originally approved 1988. Most recent review/revision, October 2002. Abridged from
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, DIAGNOSIS, AND SCREENING
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 β-cell destruction, usually leading to …