Summary of Revisions for the 2010 Clinical Practice Recommendations

B eginning with the 2005 supplement , the Clinical Practice Recommendations contained only the " Standards of Medical Care in Diabetes " and selected other position statements. This change was made to emphasize the importance of the " Standards " as the best source to determine American Diabetes Association (ADA) recommendations. The position statements in the supplement are updated yearly. Position statements not included in the supplement will be updated as necessary and repub-lished when updated. A list of the position statements not included in this supplement appears on p. S98. Additions to the " Standards of Medical Care in Diabetes " ● A section on bariatric surgery has been added. ● A section on discharge planning has been added to " Diabetes care in the hospital. " Revisions to the " Standards of Medical Care in Diabetes " ● In the " Testing for type 2 diabetes in children " section, small-for-gestational-age birth weight has been added to the list of conditions associated with insulin resistance. ● Testing should begin at age 10 years or at onset of puberty, if puberty occurs at a younger age, and should be repeated every 3 years. (E) ● In the " Prevention/delay of type 2 diabetes " section, the recommendation has been revised to clarify that one-time counseling is not adequate. ● Patients with impaired glucose tolerance (A) or impaired fasting glucose (E) should be referred to an effective ongoing support program for weight loss of 5–10% of body weight and for increasing physical activity to at least 150 min per week of moderate activity such as walking. Diabetes care: ● For patients using less frequent insulin injections, noninsulin therapies, or medical nutrition therapy and physical therapy alone, self-monitoring of blood glucose (SMBG) may be useful as a guide to the success of therapy. (E) ● In the " Glucose monitoring " section, continuous glucose monitoring (CGM) has been revised with recommendations. ● CGM in conjunction with intensive insulin regimens can be a useful tool to lower A1C in selected adults (aged Ն25 years) with type 1 diabetes (A). ● Although the evidence for A1C lowering is less strong in children, teens, and younger adults, CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device. (C) ● CGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypo-glycemic episodes. (E) …