Lessons in Care: Insights Into Recent Changes in the American Diabetes Association's Clinical Practice Recommendations.

Abstract

In January, the American Diabetes Association (ADA) published the Standards of Medical Care in Diabetes—2017 (1), its comprehensive evidence-based clinical practice recommendations for the care of people with or at risk for diabetes. The Standards are updated annually by the ADA’s Professional Practice Committee (available at http://care.diabetesjournals.org/content/40/Supplement_1) based on the latest clinical research and are funded from the ADA’s general fund without industry support. In addition, the ADA publishes occasional position statements on a range of diabetes-related topics, most recently neuropathy (2), hypoglycemia (3), and physical activity (4). Following are some highlights from the ADA’s 2017 Standards and from recent position statements, tailor-made for busy point-of-care providers. ### Tap Into Community Resources The latest Standards include new recommendations aimed at reducing health disparities stemming from discrimination, racism, socioeconomic status, lack of health care access, and language barriers, among other factors, by encouraging providers to refer patients to community resources. Furthermore, ADA makes the assertion, based on high-quality evidence for benefit, that patients should be provided self-management support from lay health coaches, navigators, or community health workers. ### More Candidates for Metabolic Surgery Obesity management is a treatment for type 2 diabetes, and the specific approach—lifestyle, pharmacologic, or metabolic surgery—should be individualized according to a patient’s characteristics and preferences. A big change for 2017 was the expansion of the pool of patients for which metabolic surgery is an appropriate treatment. Based on the findings of an international workgroup report, ADA now suggests metabolic surgery for: