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Summary of Revisions for the 2013 Clinical Practice Recommendations
In addition to many small changes related to new evidence since the prior year, and to clarify recommendations, the following sections have undergone more substantive changes:
· Section II.C. Screening for Type 1 Diabetes has been revised to include more specific recommendations.
· Section IV. Prevention/Delay of Type 2 Diabetes has been revised to reflect the importance of screening for and treating other cardiovascular risk factors.
· Section V.C.a. Glucose Monitoring has been revised to highlight the need for patients on intensive insulin regimens to do frequent self-monitoring of blood glucose.
· Section V.D. Pharmacological and Overall Approaches to Treatment has been revised to add a section with more specific recommendations for insulin therapy in type 1 diabetes.
· Section V.F. Diabetes Self-Management Education and Support has been revised to be consistent with the newly revised National Standards for Diabetes Self-Management Education and Support.
· Section V.K. Hypoglycemia has been revised to emphasize the need to assess hypoglycemia and cognitive function when indicated.
· Section V.M. Immunization has been updated to include the new Centers for Disease Control and Prevention (CDC) recommendations for hepatitis B vaccination for people with diabetes.
· Section VI.A.1. Hypertension/Blood Pressure Control has been revised to suggest that the systolic blood pressure goal for many people with diabetes and hypertension should be <140 mmHg, but that lower systolic targets (such as <130 mmHg) may be appropriate for certain individuals, such as younger patients, if it can be achieved without undue treatment burden.
· Section VI.A.2. Dyslipidemia/Lipid Management and Table 10 have been revised to emphasize the importance of statin therapy over particular LDL cholesterol goals in high-risk patients.
· Section VI.B. Nephropathy Screening and Treatment and Table 11 have been revised to highlight increased urinary albumin excretion over the terms micro- and macroalbuminuria, other than when discussion of past studies requires the distinction.
· Section VI.C. Retinopathy Screening and Treatment has been revised to include anti–vascular endothelial growth factor therapy for diabetic macular edema.
· Section IX.A. Diabetes Care in the Hospital has been revised to include a recommendation to consider obtaining an A1C in patients with risk factors for undiagnosed diabetes who exhibit hyperglycemia in the hospital.
· The position statement “Diagnosis and Classification of Diabetes Mellitus” has been revised slightly to add newer information about monogenic forms of diabetes.
· The task force report “National Standards for Diabetes Self-Management Education and Support” represents a major revision completed in 2012.
COMMENT: The above summary highlights the changes in the ADA’s 2013 standards of care. One major change is the increase from 130 to 140 mmHg as the goals for the treatment of hypertension in people with diabetes.