ADA Publishes Diabetes 'Standards of Care' for PCPs

Lara C. Pullen, PhD

April 24, 2015

The American Diabetes Association (ADA) has published an abridged version of their Standards of Medical Care in Diabetes designed to provide essential information for primary care providers (PCPs) in the spring 2015 issue of Clinical Diabetes.

"We realize that the majority of patients with diabetes are cared for by primary care providers, and we realize that they are managing many disease states beyond diabetes," Jane Chiang, MD, senior vice president, Medical Affairs and Community Information, ADA, told Medscape Medical News.

The abridged document is a tool to aid these providers in their patient care, with the most relevant information selected from the original Standards of Medical Care in Diabetes by PCPs.

This is the second year the ADA has published abridged guidelines for PCPs. This year the abridged guidelines are in a new, more accessible format. Dr Chiang identified several noteworthy changes in the 2015 guidelines:

  • Consider testing for diabetes and prediabetes in Asian Americans with a body mass index (BMI) of 23 kg/m2 or higher. This is a decrease from last year's recommendation of testing of individuals with a BMI of 25 kg/m2 or higher.

  • Glycemic targets are now 80 to 130 mg/dL, which is higher than the target of 70 to 130 mg/dL that was recommended last year.

  • An updated diabetes type 2 algorithm includes newer therapies.

  • The initiation and intensification of statin therapy is now based on age and risk factors. This reflects a change from recommending treatment on the basis of cholesterol measurements to determining treatment based on risk stratification.

  • Perform a foot exam on patients with diabetes at every visit, and not just annually, as was recommended last year.

  • The new A1C goal for children and adolescents is lower than 7.5%, regardless of age. This represents a lowering of the goal for children younger than 12 years.

The A1C goal for children and adolescents was revised on the basis of new evidence indicating that higher prepubertal blood glucose levels can have a negative effect on complications, Dr. Chiang noted. Newer data also suggest that the risk for hypoglycemia in children and adolescents is not as large as was previously believed.

Finally, and most important, explained Dr Chiang, there are now newer ways of monitoring and treating high blood sugar that make the revised A1C goals attainable.

The abridged Standards of Care also includes a new section about the management of diabetes in pregnancy.

The full Standards of Care document is available on the ADA website. The website also has a Standards of Care mobile app.

Dr Chiang has disclosed no relevant financial relationships.

Clin Diabetes. 2015;33:97-111. Full text

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