Diabetes Management Guidelines

American Diabetes Association (ADA) 2013 Guidelines 

 

Updated recommendations are available. Click here. 

Source: American Diabetes Association. Standards of medical care in diabetes—2013. Diabetes Care. 2013;36(suppl 1):S11-S66.  

Jump to a section or click the arrow at the bottom right of each section 

Criteria for Diagnosis
A1C Testing
Individualized Treatment Goals
Type 2 Diabetes Risk Factors
Lifestyle Changes
Type 2 Diabetes Treatment
Insulin Therapy
Diabetes Self-Management
Obesity Treatment
Diabetes and Hypertension
Diabetes and Lipids
Diabetes and Cardiovascular Disease 
Microvascular Complications of Diabetes
Hypoglycemia
Foot Care
Diabetes in the Hospital
Diabetes and Quality of Life
Diabetes and Vaccines
Diabetes and Children
Diabetes and Pregnancy
Diabetes and Older Adults
Diabetes and Cystic Fibrosis
Type 1 Diabetes Screening and Insulin Therapy 

 Type 2 Diabetes Risk Factors     Updated recommendations are available. Click here. 

Recommendations Slides

Categories of Increased Risk for Type 2 Diabetes (Prediabetes) 

FPG 100 mg/dl–125 mg/dL (5.6 mmol/L–6.9 mmol/L) (IFG) or

 

2-hour PG on 75-g OGTT 140 mg/dL–199 mg/dL (7.8 mmol/L–11.0 mmol/L) (IGT) or

 

A1C 5.7%–6.4%  

  • For all tests, risk is continuous, extending below lower limit of  range and becoming disproportionately greater at higher ends of range 
  • IFG and IGT should be viewed as risk factors for diabetes and CVD  

 

Testing for Type 2 Diabetes and Prediabetes 

  • Consider testing for type 2 diabetes and prediabetes in all adults with BMI ≥25 kg/m2 and ≥1 additional risk factor (note that at-risk BMI may be lower in some ethnic groups):  
    • Physical inactivity 
    • First-degree relative with diabetes 
    • High-risk race/ethnicity 
    • Women who delivered a baby weighing >9 lb or were diagnosed with GDM  
    • HDL-C <35 mg/dL and/or TG >250 mg/dL 
    • Hypertension (≥140/90 mm Hg or on therapy) 
    • A1C ≥5.7%, IGT, or IFG on previous testing 
    • Conditions associated with insulin resistance (eg, severe obesity, acanthosisnigricans, women with polycystic ovary syndrome) 
    • History of CVD  
  • In the absence of risk factors, testing should begin no later than age 45                                                     
  • If results are normal, repeat testing in ≥3-year intervals or more frequently depending on initial test results and presence of risk factors
     
     

 Prevention/Delay of Type 2 Diabetes 

  • Refer patients with IGT, IFG, or A1C 5.7%–6.4% to ongoing support program targeting weight loss (7% of body weight) and increased physical activity (≥150 min/week moderate activity) 
  • Consider metformin therapy for type 2 diabetes prevention among those with IGT, IFG, or A1C 5.7%–6.4%  
    • Especially with BMI >35 kg/m2, persons aged <60 yrs, and women with prior GDM  
  • Annually monitor individuals with prediabetes for diabetes development 
  • Screening for and treatment of modifiable CVD risk factors (obesity, hypertension, and dyslipidemia) is suggested 

Common Comorbidities 

Consider assessment and treatment for common type 2 diabetes-associated comorbidities in patients with risk factors, signs, or symptoms of 

  • Certain cancers 
  • Cognitive impairment 
  • Depression 
  • Dyslipidemia  
  • Fatty liver disease 
  • Fractures 
  • Hearing impairment 
  • Hypertension 
  • Low testosterone (men) 
  • Obesity 
  • Obstructive sleep apnea 
  • Periodontal disease  
 

ADA Guidelines: Categories of Increased Risk for Diabetes (Prediabetes) 

 

 

 

 

 

 

 

 

ADA Guidelines: Criteria for Diabetes Testing in Asymptomatic Adults 

  

  

  

  

  

  

  

 

 

ADA Guidelines: Prevention/Delay of Type 2 Diabetes 

 

 

 

ADA Guidelines: Common Comorbidities Associated With Diabetes 

 

 

Also see:  

ADA Guidelines: Primary Prevention of Type 2 Diabetes With Medical Nutrition Therapy 

 

 

Back Individualized Treatment Goals  Next Lifestyle Changes 

BMI=body mass index; CVD=cardiovascular disease; FPG=fasting plasma glucose; GDM=gestational diabetes mellitus; IFG=impaired fasting glucose; IGT=impaired glucose tolerance; OGTT=oral glucose tolerance test; PG=plasma glucose; TG=triglycerides  

January 2013 

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Last Modified: 3/13/2014

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