1.0.0.0 Di­a­betes and Pop­u­la­tion Health

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.

DI­A­BETES AND POP­U­LA­TION HEALTH

Pop­u­la­tion health is defined as “the health out­comes of a group of in­di­vid­u­als, in­clud­ing the dis­tri­bu­tion of health out­comes with­in the group”; these out­comes can be mea­sured in terms of health out­comes (mor­tal­i­ty, mor­bid­i­ty, health, and func­tion­al sta­tus), dis­ease bur­den (in­ci­dence and preva­lence), and be­hav­ioral and metabol­ic fac­tors (ex­er­cise, diet, A1C, etc.) (1). Clin­i­cal prac­tice rec­om­men­da­tions for health care pro­viders are tools that can ul­ti­mate­ly im­prove health across pop­u­la­tions; how­ev­er, for op­ti­mal out­comes, di­a­betes care must also be in­di­vid­u­alized for each pa­tient. Thus, ef­forts to im­prove pop­u­la­tion health will re­quire a com­bi­na­tion of sys­tem-‍level and pa­tient-‍level ap­proach­es. With such an in­te­grat­ed ap­proach in mind, the Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) high­lights the im­por­tance of pa­tient-centered care, defined as care that is re­spect­ful of and re­spon­sive to in­di­vid­u­al pa­tient pref­er­ences, needs, and val­ues and that en­sures that pa­tient val­ues guide all clin­i­cal de­ci­sions (2). Clin­i­cal prac­tice rec­om­men­da­tions, whether based on ev­i­dence or ex­pert opin­ion, are in­tend­ed to guide an over­all ap­proach to care. The sci­ence and art of medicine come to­geth­er when the clin­i­cian is faced with mak­ing treat­ment rec­om­men­da­tions for a pa­tient who may not meet the el­i­gi­bil­i­ty cri­te­ria used in the stud­ies on which guide­lines are based. Rec­og­niz­ing that one size does not fit all, the stan­dards pre­sent­ed here pro­vide guid­ance for when and how to adapt rec­om­men­da­tions for an in­di­vid­u­al.