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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.

Man­ag­ing the daily health de­mands of di­a­betes can be chal­leng­ing. Peo­ple liv­ing with di­a­betes should not have to face ad­di­tion­al dis­crim­i­na­tion due to di­a­betes. By ad­vo­cat­ing for the rights of those with di­a­betes at all lev­els, the Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) can help to en­sure that they live a healthy and pro­duc­tive life. A strate­gic goal of the ADA is that more chil­dren and adults with di­a­betes live free from the bur­den of dis­crim­i­na­tion. The ADA is also fo­cused on mak­ing sure cost is not a bar­ri­er to suc­cess­ful di­a­betes man­age­ment.

One tac­tic for achiev­ing these goals has been to im­ple­ment the ADA’s Stan­dards of Care through ad­vo­ca­cy-‍ori­ent­ed po­si­tion state­ments. The ADA pub­lish­es ev­i­dence-‍based, peer-‍re­viewed state­ments on top­ics such as di­a­betes and em­ploy­ment, di­a­betes and driv­ing, in­sulin ac­cess and af­ford­abil­i­ty, and di­a­betes man­age­ment in cer­tain set­tings such as schools, child care pro­grams, and cor­rec­tion­al in­sti­tu­tions. In ad­di­tion to the ADA’s clin­i­cal doc­u­ments, these ad­vo­ca­cy state­ments are im­por­tant tools in ed­u­cat­ing schools, em­ploy­ers, li­cens­ing agen­cies, pol­i­cy mak­ers, and oth­ers about the in­ter­sec­tion of di­a­betes medicine and the law and for pro­vid­ing sci­en­tifically sup­port­ed pol­i­cy rec­om­men­da­tions.

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2.0.0.0 AD­VO­CA­CY STATE­MENTS

2.1.0.0 In­tro­duc­tion

Par­tial list, with the most re­cent pub­li­ca­tions ap­pear­ing first

In­sulin Ac­cess and Af­ford­abil­i­ty Work­ing Group: Con­clu­sions and Rec­om­men­da­tions (1) (first pub­li­ca­tion 2018)

The ADA’s In­sulin Ac­cess and Af­ford­abil­i­ty Work­ing Group com­piled pub­lic in­for­ma­tion and con­vened a se­ries of meet­ings with stake­hold­ers through­out the in­sulin sup­ply chain to learn how each en­ti­ty af­fects the cost of in­sulin for the con­sumer. Their con­clu­sions and rec­om­men­da­tions are pub­lished in the ADA state­ment “In­sulin Ac­cess and Af­ford­abil­i­ty Work­ing Group: Con­clu­sions and Rec­om­men­da­tions” (https://doi.org/10.2337/dci18-0019).

Sug­gest­ed ci­ta­tion: Amer­i­can Di­a­betes As­so­ci­a­tion. 16. Di­a­betes ad­vo­ca­cy: Stan­dards of Med­i­cal Care in Di­a­betesd2019. Di­a­betes Care 2019;42(Suppl. 1):S182–S183 © 2018 by the Amer­i­can Di­a­betes As­so­ci­a­tion. Read­ers may use this ar­ti­cle as long as the work is prop­er­ly cited, the use is ed­u­ca­tion­al and not for prof­it, and the work is not al­tered. More in­for­ma­tion is avail­able at http://www.di­a­betesjournals .org/‍content/‍li­cense.

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2.2.0.0 Di­a­betes Care in the School Set­ting (2)(first pub­li­ca­tion 1998; lat­est re­vi­sion 2015)

A siz­able por­tion of a child’s day is spent in school, so close com­mu­ni­ca­tion with and co­op­er­a­tion of school per­son­nel are es­sen­tial to op­ti­mize di­a­betes man­age­ment, safe­ty, and aca­dem­ic op­por­tu­ni­ties. See the ADA po­si­tion state­ment “Di­a­betes Care in the School Set­ting”(https://doi.org/10.2337/dc15-1418).

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2.3.0.0 Care of Young Chil­dren With Di­a­betes in the Child Care Set­ting (3) (first pub­li­ca­tion 2014)

Very young chil­dren (aged <6 years) with di­a­betes have legal pro­tec­tions and can be safe­ly cared for by child care pro­viders with ap­pro­pri­ate train­ing, ac­cess to re­sources, and a sys­tem of com­mu­ni­ca­tion with par­ents and the child’s di­a­betes pro­vider. See the ADA po­si­tion state­ment “Care of Young Chil­dren With Di­a­betes in the Child Care Set­ting” (https://doi.org/10.2337/dc14-1676).

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2.4.0.0 Di­a­betes and Driv­ing (4) (first pub­li­ca­tion 2012)

Peo­ple with di­a­betes who wish to op­er­ate motor ve­hi­cles are sub­ject to a great va­ri­ety of li­cens­ing re­quire­ments ap­plied by both state and fed­er­al ju­ris­dic­tions, which may lead to loss of em­ploy­ment or sig­nif­i­cant re­stric­tions on a per­son’s li­cense. Pres­ence of a med­i­cal con­di­tion that can lead to significant­ly im­paired con­scious­ness or cog­ni­tion may lead to drivers being eval­u­ated for their fitness to drive. Peo­ple with di­a­betes should be in­di­vid­u­al­ly as­sessed by a health care pro­fes­sion­al knowl­edge­able in di­a­betes if li­cense re­stric­tions are being con­sid­ered, and pa­tients should be coun­seled about de­tect­ing and avoid­ing hy­po­glycemia while driv­ing. See the ADA po­si­tion state­ment “Di­a­betes and Driv­ing” (https://doi.org/10.2337/dc14-S097).

Ed­i­tor’s note: Fed­er­al com­mer­cial driv­ing rules for in­di­vid­u­als with in­sulin-treat­ed di­a­betes changed on 19 Novem­ber 2018. These changes will be reflected in an up­dat­ed ADA state­ment.

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2.5.0.0 Di­a­betes and Em­ploy­ment (5) (first pub­li­ca­tion 1984; lat­est re­vi­sion 2009)

Any per­son with di­a­betes, whether in­sulin treat­ed or nonin­sulin treat­ed, should be el­i­gi­ble for any em­ploy­ment for which he or she is oth­er­wise qualified. Em­ploy­ment de­ci­sions should never be based on gen­er­alizations or stereo­types re­gard­ing the ef­fects of di­a­betes. When ques­tions arise about the med­i­cal fitness of a per­son with di­a­betes for a par­tic­u­lar job, a health care pro­fes­sion­al with ex­pertise in treat­ing di­a­betes should per­form an in­di­vid­u­al­ized as­sess­ment. See the ADA po­si­tion state­ment “Di­a­betes and Em­ploy­ment”(https://doi.org/10.2337/dc14-S112).

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2.6.0.0 Di­a­betes Man­age­ment in Cor­rec­tion­al In­sti­tu­tions (6) (first pub­li­ca­tion 1989; lat­est re­vi­sion 2008)

Peo­ple with di­a­betes in cor­rec­tion­al fa­cil­i­ties should re­ceive care that meets na­tion­al stan­dards. Be­cause it is es­ti­mat­ed that near­ly 80,000 in­mates have di­a­betes, cor­rec­tion­al in­sti­tu­tions should have writ­ten poli­cies and pro­ce­dures for the man­age­ment of di­a­betes and for the train­ing of med­i­cal and cor­rec­tion­al staff in di­a­betes care prac­tices. See the ADA po­si­tion state­ment “Di­a­betes Man­age­ment in Cor­rec­tion­al In­sti­tu­tions” (https://doi.org/10.2337/dc14-S104).

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3.0.0.0 Ref­er­ences

  1. Ce­falu WT, Dawes DE, Gavlak G, et al.; In­sulin Ac­cess and Af­ford­abil­i­ty Work­ing Group. In­sulin Ac­cess and Af­ford­abil­i­ty Work­ing Group: con­clu­sions and rec­om­men­da­tions [pub­lished cor­rec­tion ap­pears in Di­a­betes Care 2018;41:1831]. Di­a­betes Care 2018;41:1299– 1311
  2. Jack­son CC, Al­banese-‍O’Neill A, But­ler KL, et al. Di­a­betes care in the school set­ting: a po­si­tion state­ment of the Amer­i­can Di­a­betes As­so­ci­a­tion. Di­a­betes Care 2015;38:1958– 1963
  3. Simine­r­io LM, Al­banese-‍O’Neill A, Chi­ang JL, et al. Care of young chil­dren with di­a­betes in the child care set­ting: a po­si­tion state­ment of the Amer­i­can Di­a­betes As­so­ci­a­tion. Di­a­betes Care 2014;37:2834–2842
  4. Amer­i­can Di­a­betes As­so­ci­a­tion. Di­a­betes and driv­ing. Di­a­betes Care 2014;37(Suppl. 1):S97– S103
  5. Amer­i­can Di­a­betes As­so­ci­a­tion. Di­a­betes and em­ploy­ment. Di­a­betes Care 2014;37(Suppl. 1): S112–S117
  6. Amer­i­can Di­a­betes As­so­ci­a­tion. Di­a­betes man­age­ment in cor­rec­tion­al in­sti­tu­tions. Di­a­betes Care 2014;37(Suppl. 1):S104– S111