ADA 2014 Standards of Medical Care in Diabetes
Diabetes is a huge health care problem in the United States. Diabetes is the number one cause of renal transplantation, the number two cause of acquired blindness and a leading cause of stroke and heart attack. Physicians and veterinarians both benefit from an increased understanding of the complex pathophysiology surrounding diabetes and the rational for the treatment strategies being employed in all species. This article provides an excellent review of the current standards for the diagnosis and management of diabetes mellitus in humans. While addressing the human condition, the article provides veterinarians with information that we can use when treating diabetic dogs and cats.
Diabetes mellitus is a complex, chronic illness requiring continuous medical care with multifactorial risk reduction strategies beyond glycemic control. Ongoing patient self-management education and support are critical to preventing acute complications and reducing the risk of long-term complications. Significant evidence exists that supports a range of interventions to improve diabetes outcomes.
The American Diabetes Association’s (ADA’s) Standards of Care are intended to provide clinicians, patients, researchers, payers, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. The Standards of Care recommendations are not intended to preclude clinical judgment and must be applied in the context of excellent clinical care and with adjustments for individual preferences, comorbidities, and other patient factors.
The recommendations include screening, diagnostic, and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. Many of these interventions have also been shown to be cost-effective. A grading system developed by ADA and modeled after existing methods was used to clarify and codify the evidence that forms the basis for the recommendations. The letters A, B, C, or E show the evidence level that supports each recommendation. The Standards of Care conclude with evidence and recommendations for strategies to improve the process of diabetes care. It must be emphasized that clinical evidence and expert recommendations alone cannot improve patients’ lives, but must be effectively translated into clinical management.