Diabetes Forecast

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How the experts make big diabetes decisions


Ever wonder why your doctor insists that you have an annual dilated eye exam? Or who chose the magic number 7 for A1C? The answer would be, in part, the American Diabetes Association, which brings together top physicians in the field to create guidelines for physicians, nurses, dietitians, and other health care providers.

The Standards of Medical Care in Diabetes is a document published annually as a supplement to the ADA journal Diabetes Care. Each year, these standards—and other more specific documents called Clinical Practice Recommendations—are reviewed, evaluated, and modified to reflect the latest research. Leading endocrinologists, primary care physicians, certified diabetes educators, dietitians, pharmacists, epidemiologists, pediatricians, and other health care professionals come together to form the Professional Practice Committee (PPC). ADA Vice President of Clinical Affairs M. Sue Kirkman, MD, explains that the professionals who comprise the PPC are practicing clinicians and sometimes researchers to boot, all of whom are up to date with the current medical literature—and questioning and reviewing their patient recommendations on a daily basis.

The information that ultimately appears in the Standards of Medical Care is often drawn from longer, more detailed position statements. These statements reflect the opinion of the ADA as a whole, and tend to carry the most weight. ADA has issued position statements on a range of topics, from "Diagnosis and Classification of Diabetes Mellitus" to "Diabetes Care in the School and Day Care Setting." "A position statement has to be approved by the PPC, and by the Executive Committee of the Board of Directors," Kirkman says. The Executive Committee includes top experts in the field of diabetes care and research, including ADA President of Medicine and Science John B. Buse, MD, PhD, and ADA President of Health Care and Education Ann Albright, PhD, RD.

These experts who collaborate, create, and sign off on recommendations also designate a level of evidence associated with every recommendation. The evidence-grading system ranges from letters A through E, with "A" indicating the highest level of evidence to support the recommendation, based on large trials and extensive research and review.

"A lot of quality improvement programs use our guidelines," Kirkman says. Health care systems in other countries often base their own recommendations on ADA's, Kirkman says. Other U.S. diabetes organizations also have input in—and take input from—the statements ADA publishes.

"There's frequently cross-talk between organizations, like the American Association of Diabetes Educators, ADA, and others," Kirkman explains. "We sometimes partner with others on consensus statements. For instance, in the April issue of Diabetes Care, we published a joint consensus statement with the American College of Cardiology."

Fortunately, countless trials and research over the years have expanded the base of knowledge about diabetes, giving ADA more information with which to make important care recommendations to health care professionals throughout the field.

"With all the trials presented at the ADA Scientific Sessions this year, like VA, ACCORD, and ADVANCE, [we'll see that] glycemic control and cardiovascular disease will be addressed for next year's recommendations," says Kirkman. She also mentions bariatric surgery, more specific recommendations for low-carb diets, and whether low-fat and low-carb are equally effective as issues that need to be addressed in the near future.

"There's so much more known about diabetes than 20 years ago," Kirkman says. "From glycemic goals, to physical activity, to lipid screening and treatment … we need to be looking at lots of important things."



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