Clinical Practice Recommendations

During the past 3 years, Clinical Diabetes has published “Diabetes Foundation,” a 12-part series intended to explain and review facets of diabetes care for general physicians and physicians in training. The goal of the series has been to improve diabetes care for patients treated by such physicians because only a very small percentage of patients with diabetes have access to an endocrinologist. Although previous articles have focused on individual topics related to diabetes care and have reviewed available scientific data, this final article will focus on summarizing recommendations from the American Diabetes Association (ADA) and integrating them as a set of clinical practice guidelines. Information supporting the recommendations has appeared in the previous installments of “Diabetes Foundation” and from the ADA. Although there are always exceptions, it is likely that the majority of patients with diabetes or glucose abnormalities would benefit from implementation of many of these guidelines for both prevention of diabetes and prevention of the complications of diabetes and diabetes treatments. Whom to Screen for Diabetes or Pre-Diabetes Any patient who is experiencing symptoms of diabetes such as polyuria, polydipsia, or unexplained weight loss should be screened for diabetes, especially if they are obese or overweight (BMI > 25 kg/m2). Asymptomatic adult patients should be tested at any age if they are overweight or obese and have an additional risk factor for diabetes. Children who are overweight (BMI greater than the 85th percentile or weight > 120% of ideal for height) should be screened for type 2 diabetes if they have a family history of type 2 diabetes, are of an ethnic background predisposed to diabetes, have signs of insulin resistance such as acanthosis nigricans on physical examination, have a maternal history of diabetes or gestational diabetes, or have other conditions typically associated with type 2 diabetes. Such testing in children should begin at the age of 10 years or at the onset of puberty. If tests are normal, such patients should be screened again in 3 years. Women who have had gestational diabetes should be screened for diabetes 6–12 weeks postpartum.