ADA Standards of Care for Diabetes - click box for related education

STANDARD OF CARE	WHAT IS THIS? WHY IS IT IMPORTANT?	HOW OFTEN SHOULD THIS BE DONE?	ADA RECOMMENDATIONS OR TREATMENT GOALS
HBA1-C TESTING	This test shows the average amount of glucose in the blood over the last 2–3 months and indicates if a person’s diabetes is under control.	Test HbA1c every 6 months if the patient is in good control and at least twice a year.	The recommended level is < 7.0% when appropriate for the patient.
LDL-C TESTING OR A LIPID PANEL	Keeping low density lipid cholesterol (LDL-C) under control is recommended to decrease the incidence of heart attack and strokes. Completion of this test is the most-often used indicator of quality care for persons with diabetes.	LDL-C testing should be done annually. While a fasting lipid profile is the preferred way to test a patient, a non-fasting direct measurement of LDL-C can be performed to determine if treatment for hyperlipidemia is required.	The LDL cholesterol goal is < 100 mg/dL.
BLOOD PRESSURE & CONTROL OF B/P	High blood pressure leads to strokes, kidney and heart damage.	Blood pressure should be checked at every visit.	Control hyper tension with ACE/ARB and/or other medication as appropriate.Treat to a blood pressure of < 130/80 mmHg.
SCREENING FOR KIDNEY DISEASE OR NEPHROPATHY	Several interventions can reduce the risk and slow the progression of renal disease for people who have diabetes.	Perform an annual test to assess urine albumin excretion in type 1 DM patients with a duration of 5 years of diabetes and in all type 2 DM patients upon diagnosis. An annual urine screening for microalbuminuria (ACR) is recommended, if appropriate. Measure serum creatinine (eGFR) at least annually in all adults with diabetes.	Treatment with ACE inhibitors or ARBs should be used in the non-pregnant patient with micro or macroalbuminuria. Referral to a nephrologist may be indicated when nephropathy is present.
DILATED RETINAL EYE EXAM	A dilated eye exam can detect early disease, which allows early treatment which is important in an effort to prevent blindness.	A dilated retinal eye exam should be done on an annual basis.	Refer patients with diabetes to an optometrist or ophthalmologist every year or perform dilated retinal exams in your office.
TESTING FOR NEUROPATHY & FOOT EXAMINATIONS	Persons with diabetes may lose sensation in their feet and not notice a potential problem. Teaching self-foot inspection and care allows early treatment of problems. Diabetes can also damage the autonomic nerves, a condition called diabetic autonomic neuropathy (DAN).	For all patients with diabetes, perform an annual comprehensive foot examination to identify risk factors for ulcers or amputations. Have the patient remove their socks and shoes at each visit, so a quick foot exam can be completed. Assessment for DAN should also be performed.	A foot exam should include inspection, assessment of foot pulses and testing for loss of protective sensation with a 10-g monofilament, a tuning fork or by pinprick sensation (DPN). Testing of ankle reflexes should also be performed. Refer to podiatry as needed.
HEALTH MAINTENANCE OR WELLNESS EXAM	Preventive health care is the cornerstone of prevention of diabetes complications.	Provide preventive health care at ever y visit as needed. Check to see if your patient needs testing at each visit.	An annual health maintenance exam is recommended, as well as continuing medical care for diabetes.
IMMUNIZATIONS	Influenza, Pneumococcal and Hepatitis B vaccines prevent life threatening illnesses in persons with diabetes.	Check vaccine status at every visit, and reach out to patients to get an annual flu shot before the flu season. Administer Pneumococcal vaccines and a Hepatitis B series as indicated.	Provide annual flu vaccine for diabetic patients > 6 months old. One lifetime pneumococcal vaccine with revaccination at 65 years old if last vaccine was ≥ 5 years ago. Complete a Hepatitis B series for all < 60 years old or at provider’s discretion if > 60 years old.
TESTING FOR PERIDONATAL DISEASE	The relationship between serious gum disease and diabetes is a two-way street. Not only are people with diabetes more susceptible to serious gum disease, but serious gum disease may affect blood glucose control and contribute to the progression of diabetes.	An annual comprehensive assessment, and treatment of identified periodontal disease, is indicated in patients with diabetes.	Refer patients with diabetes to a dentist for a comprehensive periodontal examination and follow-up care.

Adapted from MDwise.org: http://www.mdwise.org/MediaLibraries/MDwise/Files/For%20Providers/Tools%20and%20Resources/Toolkits/diabetes-toolkit.pdf

THE COMPLETE ADA STANDARDS OF CARE CAN BE FOUND AT:

https://diabetesjournals.org/care/issue/48/Supplement_1