Expanded ABCs of Diabetes
- Samuel L. Abbate, MD, CDE
Each year, the American Diabetes Association (ADA) publishes clinical practice recommendations that include standards of care for patients with diabetes mellitus.1 A clear, simple message about comprehensive care has been difficult to develop because of the large number of tasks involved in fulfilling these standards of care. Providers and patients have struggled to remember the elements of appropriate care, the frequency at which tests and evaluations should be conducted, and the goals for each of the clinical standards.
The elements of comprehensive care can be remembered using an extended version of the “ABCs of Diabetes” presented below and summarized in Table 1. A summary of the recommendations for adults with diabetes is given in Table 2. Recommendations on achieving the clinical goals are detailed in the standards of care as well as in the various position statements and technical reviews of the ADA.
A: A1C
The letter “A” stands for the hemoglobin A1c (A1C) blood test and reminds patients and providers of the importance of blood glucose control in preventing the complications of diabetes. Each 1% decrease in A1C translates into a 35–40% decrease in the frequency of microvascular complications.
Standard. The A1C blood test provides a measure of a patient’s average glucose control over the preceding 2–3 months and, thus, overall treatment efficacy.2 Glycemic control is best judged by the combination of the patient’s self-monitoring of blood glucose (SMBG) results and current A1C result.
Frequency. Perform the A1C test at least two times a year for patients who are meeting treatment goals and who have stable glycemic control and quarterly for patients whose therapy has changed or who are not meeting glycemic goals. For any individual patient, the frequency of A1C testing should be dependent on the clinical situation, the treatment regimen used, and the judgment …
