The Annals of Internal Medicine reported of an ADA published study in order to compile the 2016 Standards of Medical Care in Diabetes. These standards are intended to give primary care providers, patients, researchers, payers, and others who are interested all the tools needed to properly judge and carry out quality care.
The 8 Focus Areas in Diabetes Care for Primary Care Providers
Guideline Development and Evidence Grading
Diagnosis of Diabetes
Glycemic Targets
Medical Management
Hypoglycemia
Cardiovascular Risk Factor Management
Microvascular Disease Screening and Management
In Hospital Diabetes Care
HealthDay reported the researchers recommended an individualized approach and a strong emphasis on self-monitoring of blood sugars by the patient.
The authors of the study wrote, “The synopsis focuses on eight key areas that are important to primary care providers,” and “The recommendations highlight individualized care to manage the disease, prevent or delay complications, and improve outcomes.”
The 2016 revisions Involve Important Changes, Such As:
Recommendations for tailored treatment in vulnerable patients such as those dealing with mental illness or food insecurity.
A new recommendation to screen all adults over age 45 for diabetes–regardless of weight.
A recommendation to encourage the use of technology to positively influence lifestyle habits in order to prevent or delay type 2 diabetes.
A recommendation that persons with insulin-dependent diabetes relying on continuous glucose monitors and insulin pumps continue to be able to do so after age 65.
Recommendations calling for better nuanced care provided to elderly, child, and adolescent patients with diabetes.
A1c recommendations for pregnant women with diabetes changed from <6% to between 6-6.5%.
How Did Researchers Decide on New Guidelines?
Dr. James J. Chamberlain St. Mark’s Hospital and St. Mark’s Diabetes Center in Salt Lake City, Utah and team, including the ADA Professional Practice Committee (PPC) systematically reviewed current recommendations for diabetes diagnosis and management care. He and his team created these recommendations and protocol based on new evidence.
The PPC assigned the recommendations a rating of A, B, or C depending on the quality of the evidence. An example of an “A” rated recommendation derived from the study: “An insulin regimen with basal, nutritional, and correction components (basal–bolus) is the preferred treatment for patients with good nutritional intake.” Also utilized was an E rating for expert opinion which lacked clinical evidence. An example of a recommendation with an “E” rating: “In the critical care setting, continuous intravenous insulin infusion is the best method for achieving glycemic targets.”
Ultimately, all the recommendations were rated and reviewed by the Executive Committee of the ADA Board of Directors who approved of the new guidelines. This committee included health care professionals, scientists, and laypersons. In addition, the 2016 revision of the guidelines included input from the larger clinical community.
It may be important to note that each member of the PPC reported a potential conflict of interest.
The authors also added, “The ADA funds development of the Standards out of its general revenues and does not use industry support for these purposes.”
Options for the viewing the standards from the ADA:
Access the standards.
View the full PDF.
Order your print copy of the Diabetes Care supplement containing the full Standards of Care.
photo credit: The American Diabetes Association and adobe stock