In­tro­duc­tion and Method­ol­o­gy: Stan­dards of Care in Di­a­betes—2023

Overview

Introduction and Methodology: Standards of Care in Diabetes—2023

Di­a­betes Care 2023;46(Sup­pl. 1):S1–S4 | https:/​/​doi.org/​10.2337/​dc23-​SINT

Nuha A. El­Sayed, Grazia Alep­po, Vani­ta R. Ar­o­da, Raveend­hara R. Ban­nu­ru, Flo­rence M. Brown, Den­nis Bruem­mer, Bil­ly S. Collins, Ken­neth Cusi, Sandeep R. Das, Christo­pher H. Gib­bons, John M. Giuri­ni, Marisa E. Hilliard, Di­ana Isaacs, Eric L. John­son, Scott Ka­han, Kam­lesh Khunti, Mikhail Kosi­borod, Jose Leon, Sarah K. Lyons, Lisa Mur­dock, Mary Lou Per­ry, Priya Pra­ha­l­ad, Richard E. Prat­ley, Jane Jef­frie Se­ley, Robert C. Stan­ton, Jen­nifer K. Sun, Crys­tal C. Wood­ward, Deb­o­rah Young-​Hy­man, and Robert A. Gab­bay, on be­half of the Amer­i­can Di­a­betes As­so­ci­a­tion

Di­a­betes is a com­plex, chron­ic con­di­tion re­quir­ing con­tin­u­ous med­i­cal care with mul­ti­fac­to­ri­al risk-​re­duc­tion strate­gies be­yond glu­cose man­age­ment. On­go­ing di­a­betes self-​man­age­ment ed­u­ca­tion and sup­port are crit­i­cal to em­pow­er­ing peo­ple, 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 (ADA) “Stan­dards of Care in Di­a­betes,” re­ferred to here as the Stan­dards of Care, is in­tend­ed to pro­vide clin­i­cians, re­searchers, pol­i­cy mak­ers, and oth­er in­ter­est­ed in­di­vid­u­als with the com­po­nents of di­a­betes care, gen­er­al treat­ment goals, and tools to eval­u­ate the qual­i­ty of care.

The ADA Pro­fes­sion­al Prac­tice Com­mit­tee (PPC) up­dates the Stan­dards of Care an­nu­al­ly and strives to in­clude dis­cus­sion of emerg­ing clin­i­cal con­sid­er­a­tions in the text, and as ev­i­dence evolves, clin­i­cal guid­ance is added to the rec­om­men­da­tions in the Stan­dards of Care. The Stan­dards of Care is a “liv­ing“ doc­u­ment where im­por­tant up­dates are pub­lished on­line should the PPC de­ter­mine that new ev­i­dence or reg­u­la­to­ry changes (e.g., drug or tech­nol­o­gy ap­provals, la­bel changes) mer­it im­me­di­ate in­clu­sion. More in­for­ma­tion on the “Liv­ing Stan­dards” can be found on the ADA pro­fes­sion­al web­site Di­a­bete­sPro at pro­fes­sion­al.di­a­betes.org/​con­tent-​page/​liv­ing-​stan­dards. The Stan­dards of Care su­per­sedes all pre­vi­ous­ly pub­lished ADA po­si­tion state­ments—and the rec­om­men­da­tions there­in—on clin­i­cal top­ics with­in the purview of the Stan­dards of Care; while still con­tain­ing valu­able analysis, ADA po­si­tion state­ments should not be con­sid­ered the cur­rent po­si­tion of the ADA. The Stan­dards of Care re­ceives an­nu­al re­view and ap­proval by the ADA Board of Di­rec­tors and is re­viewed by ADA staff and clin­i­cal lead­er­ship. The Stan­dards of Care also un­der­goes ex­ter­nal peer re­view an­nu­al­ly.

SCOPE OF THE GUIDE­LINES

The rec­om­men­da­tions in the Stan­dards of Care in­clude screen­ing, di­ag­nos­tic, and ther­a­peu­tic ac­tions that are known or be­lieved to fa­vor­ably af­fect health out­comes of peo­ple with di­a­betes. They also cov­er the pre­ven­tion, screen­ing, di­ag­no­sis, and man­age­ment of di­a­bete­s-as­so­ci­at­ed com­pli­ca­tions and co­mor­bidi­ties. The rec­om­men­da­tions en­com­pass care through­out the lifes­pan, for youth (chil­dren aged birth to 11 years and ado­les­cents aged 12–17 years), adults (aged 18–64 years), and old­er adults (aged ≥65 years). The rec­om­men­da­tions cov­er the man­age­ment of type 1 di­a­betes, type 2 di­a­betes, ges­ta­tion­al di­a­betes mel­li­tus, and oth­er types of di­a­betes.

The Stan­dards of Care does not pro­vide com­pre­hen­sive treat­ment plans for com­pli­ca­tions as­so­ci­at­ed with di­a­betes, such as di­a­bet­ic retinopa­thy or di­a­bet­ic foot ul­cers, but of­fers guid­ance on how and when to screen for di­a­betes com­pli­ca­tions, man­age­ment of com­pli­ca­tions in the pri­ma­ry care and di­a­betes care set­tings, and re­fer­ral to spe­cial­ists as ap­pro­pri­ate. Sim­i­lar­ly, re­gard­ing the psy­choso­cial fac­tors of­ten as­so­ci­at­ed with di­a­betes and that can af­fect di­a­betes care, the Stan­dards of Care pro­vides guid­ance on how and when to screen, man­age­ment in the pri­ma­ry care and di­a­betes care set­tings, and re­fer­ral but does not pro­vide com­pre­hen­sive man­age­ment plans for con­di­tions that re­quire spe­cial­ized care, such as men­tal ill­ness.