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* Standards of medical care in diabetes - 2016 - Download the full article (as pdf file) »»


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General Changes

In alignment with the American Diabetes Association’s (ADA’s) position that diabetes does not define people, the word “diabetic” will no longer be used when referring to individuals with diabetes in the “Standards of Medical Care in Diabetes.” The ADA will continue to use the term “diabetic” as an adjective for complications related to diabetes (e.g., diabetic retinopathy).

Although levels of evidence for several recommendations have been updated, these changes are not included below as the clinical recommendations have remained the same. Changes in evidence level from, for example, C to E are not noted below. The “Standards of Medical Care in Diabetes—2016” contains, in addition to many minor changes that clarify recommendations or reflect new evidence, the following more substantive revisions. Previous Section

Section Changes

  • Section 1. Strategies for Improving Care

This section was revised to include recommendations on tailoring treatment to vulnerable populations with diabetes, including recommendations for those with food insecurity, cognitive dysfunction and/or mental illness, and HIV, and a discussion on disparities related to ethnicity, culture, sex, socioeconomic differences, and disparities.

  • Section 2. Classification and Diagnosis of Diabetes

The order and discussion of diagnostic tests (fasting plasma glucose, 2-h plasma glucose after a 75-g oral glucose tolerance test, and A1C criteria) were revised to make it clear that no one test is preferred over another for diagnosis.

To clarify the relationship between age, BMI, and risk for type 2 diabetes and prediabetes, the ADA revised the screening recommendations. The recommendation is now to test all adults beginning at age 45 years, regardless of weight.

Testing is also recommended for asymptomatic adults of any age who are overweight or obese and who have one or more additional risk factors for diabetes. Please refer to Section 2 for testing recommendations for gestational diabetes mellitus.

For monogenic diabetes syndromes, there is specific guidance and text on testing, diagnosing, and evaluating individuals and their family members.

  • Section 3. Foundations of Care and Comprehensive Medical Evaluation

Section 3 “Initial Evaluation and Diabetes Management Planning” and Section 4 “Foundations of Care: Education, Nutrition, Physical Activity, Smoking Cessation, Psychosocial Care, and Immunization” from the 2015 Standards were combined into one section for 2016 to reflect the importance of integrating medical evaluation, patient engagement, and ongoing care that highlight the importance of lifestyle and behavioral modification. The nutrition and vaccination recommendations were streamlined to focus on those aspects of care most important and most relevant to people with diabetes.

  • Section 4. Prevention or Delay of Type 2 Diabetes

To reflect the changing role of technology in the prevention of type 2 diabetes, a recommendation was added encouraging the use of new technology such as apps and text messaging to affect lifestyle modification to prevent diabetes.

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