Standards of Medical Care in Diabetes—2008

Diabetes is a chronic illness that requirescontinuing medical care andpatient self-management educationto prevent acute complications and to reducethe risk of long-term complications.Diabetes care is complex and requires thatmany issues, beyond glycemic control, beaddressed. A large body of evidence existsthat supports a range of interventions toimprove diabetes outcomes.

 These standards of care are intendedto provide clinicians, patients, researchers,payors, and other interested individualswith the components of diabetescare, treatment goals, and tools to evaluatethe quality of care. While individualpreferences, comorbidities, and other patientfactors may require modification ofgoals, targets that are desirable for mostpatients with diabetes are provided.These standards are not intended to precludemore extensive evaluation andmanagement of the patient by other specialistsas needed. For more detailed information,refer to refs. 1–3.

 The recommendations included arescreening, diagnostic, and therapeutic actionsthat are known or believed to favorablyaffect health outcomes of patientswith diabetes. A grading system (Table 1),developed by the American Diabetes Association(ADA) and modeled after existing methods, was utilized to clarify andcodify the evidence that forms the basisfor the recommendations. The level of evidencethat supports each recommendationis listed after each recommendationusing the letters A, B, C, or E.