1.0.0.0 In­tro­duc­tion

The Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) “Stan­dards of Med­i­cal Care in Di­a­betes” in­cludes ADA’s cur­rent clin­i­cal prac­tice rec­om­men­da­tions and is in­tend­ed to pro­vide the com­po­nents of di­a­betes care, gen­er­al treat­ment goals and guide­lines, and tools to eval­u­ate qual­i­ty of care. Mem­bers of the ADA Pro­fes­sion­al Prac­tice Com­mit­tee, a mul­ti­dis­ci­plinary ex­pert com­mit­tee, are re­spon­si­ble for up­dat­ing the Stan­dards of Care an­nu­al­ly, or more fre­quent­ly as war­rant­ed. For a de­tailed de­scrip­tion of ADA stan­dards, state­ments, and re­ports, as well as the ev­i­dence-‍grad­ing sys­tem for ADA’s clin­i­cal prac­tice rec­om­men­da­tions, please refer to the Stan­dards of Care In­tro­duc­tion. Read­ers who wish to com­ment on the Stan­dards of Care are in­vit­ed to do so at pro­fes­sion­al.di­a­betes.org/‍SOC. 

For guide­lines re­lat­ed to screen­ing for in­creased risk for type 2 di­a­betes (predi­a­betes), please refer to Sec­tion 2 “Clas­sification and Di­ag­no­sis of Di­a­betes.”

Screen­ing for predi­a­betes and type 2 di­a­betes risk through an in­for­mal as­sess­ment of risk fac­tors (Table 2.3) or with an as­sess­ment tool, such as the Amer­i­can Di­a­betes As­so­ci­a­tion risk test (Fig. 2.1), is rec­om­mend­ed to guide pro­viders on whether per­form­ing a di­ag­nos­tic test for predi­a­betes (Table 2.5) and pre­vi­ous­ly un­di­ag­nosed type 2 di­a­betes (Table 2.2) is ap­pro­pri­ate (see Sec­tion 2 “Clas­sification and Di­ag­no­sis of Di­a­betes”). Those de­ter­mined to be at high risk for type 2 di­a­betes, in­clud­ing peo­ple with A1C 5.7–6.4% (39–47 mmol/‍mol), im­paired glu­cose tol­er­ance, or im­paired fast­ing glu­cose, are ideal can­di­dates for di­a­betes pre­ven­tion ef­forts. Using A1C to screen for predi­a­betes may be prob­lem­at­ic in the pres­ence of cer­tain hemoglobinopathies or con­di­tions that af­fect red blood cell turnover. See Sec­tion 2 “Clas­sification and Di­ag­no­sis of Di­a­betes” and Sec­tion 6 "Glycemic Tar­gets” for ad­di­tion­al de­tails on the ap­pro­pri­ate use of the A1C test.

At least an­nu­al mon­i­tor­ing for the de­vel­op­ment of di­a­betes in those with predi­a­betes is sug­gest­ed.