ADA Releases 2010 Diabetes Care Guidelines

On December 29th, the American Diabetes Association (ADA) released the 2010 updated guidelines for diabetes. One of the major changes is that the ADA is now advocating the use of A1C testing for the diagnosis of type 2 diabetes and prediabetes. The ADA believes that by providing a faster, easier diagnostic test for diabetes, the number of undiagnosed patients will be reduced and it will be possible to better identify patients with prediabetes. The A1C blood test measures average blood sugar levels for the previous two to three months and has long been used in the management of diabetes. The new guidelines specify a diagnosis of type 2 diabetes at A1C levels exceeding 6.5%, and prediabetes for patients with A1C levels between 5.7 and 6.4 percent. According to Dr. Richard Bergenstal, president-elect of medicine and science for the ADA, "We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease.” He added “Additionally, early detection can make an enormous difference in a person's quality of life. Unlike many chronic diseases, type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."

Among the other changes in the 2010 guidelines:

• A section on diabetes related to cystic fibrosis has been added to “Standards of Medical Care in Diabetes.”

• Revisions to the section "Detection and Diagnosis of GDM (Gestational Diabetes Mellitus)” include a discussion of possible future changes in this diagnosis, according to international consensus. Women diagnosed with gestational diabetes should be screened for diabetes 6 to 12 weeks postpartum and should have subsequent screening for the development of diabetes or prediabetes.Revisions to the section "Diabetes Self-Management Education” bring a stronger focus on evidence-based strategies.

• Revisions to the section "Antiplatelet Agents" now reflect evidence from recent trials suggesting that in moderate or low-risk patients, aspirin is of questionable benefit for primary prevention of heart disease.

• Fundus photography may be used as a screening strategy for retinopathy, as described in the section "Retinopathy Screening and Treatment."

• Revisions to the section "Diabetes Care in the Hospital" now question the benefit of very tight glycemic control goals in critically ill patients, based on new evidence.

• Revisions to the section "Strategies for Improving Diabetes Care" focus on specific strategies to optimize diabetes care in physician practice settings. These include: thorough diabetes self-management education, decision-support tools and automated reminders, continuous quality improvement incorporating performance measurement, practice redesigns such as planned care visits, tracking or patient registry systems, and case (preferably care) management services using nurses and other professionals including psychologists.

With regard to the recommendations for physician practice redesign, the guidelines authors note "The most successful practices have an institutional priority for quality of care, involve all of the staff in their initiatives, redesign their delivery system, activate and educate their patients, and use electronic health record tools. It is clear that optimal diabetes management requires an organized, systematic approach and involvement of a coordinated team of dedicated health care professionals working in an environment where quality care is a priority."

The new guidelines and supporting materials were published as a supplement to the January issue of Diabetes Care and are available online.

 

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