Summary of Revisions for the 2010 Clinical Practice Recommendations B eginning with the 2005 supplement, the Clinical Practice Recom- mendations 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 recommendations. The posi- tio n sta te men ts in the sup ple men t are updated yearly. Position statements not included in the supplement will be updated as necessary and republished when updated. A list of the position statements not included in this supplement appears on p. S100. Addi tions to the “Standards of Medical Care in Diabetes” ● A section on cystic fibrosis–related diabetes has been added. Revisions to the “Standards of Medical Care in Diabetes” In add iti on to man y sma ll cha nge s rel at ed to new evidence since the previous ver- sion, the following sections have under- gone major changes: ● The section “Diagnosis of diabetes” has been revised to include the use of A1C to di agnose di ab etes, wi th a cut po int of 6.5%. ● Thesectionpreviouslytitled “Diagnosis of pre-diabetes” has been renamed “Categories of increased risk for diabetes.”In additiontoimpair ed fas ting glu - cose and imp air ed glu cos e tol era nce , an A1C range of 5.7–6.4% has been included as a category of increased risk for future diabetes. ● The sec tio n “Detection and dia gno sis of GDM” has been revised to discuss po- tential future changes in the diagnosis based on international consensus. ● The sect ion “Diab etes self- mana gemen t educ ation ” has been exte nsive ly revised to reflect new evidence. ● The section “Antiplatelet agents” has been extensively revised to reflect re- cent trials questioning the benefit of aspirin for prima ry cardiovascula r disea se prevention in moderate- or low-risk patients. The recommendation has changed to consider aspirin therapy as a primary prevention strategy in those with diabetes at increased cardiovascular risk (10-year risk 10%). This in- clu des men 50yea rs of ag e or wo me n 60 years of age with at least one ad- ditional major risk factor. ● The section “Retinopathy screening and treatment” has been updated to include a recommendation on use of fundus photography as a screening strategy. ● The section “Di abetes care in the hospi- tal” has been extensively revised to re- flec t new evi den ce ca lli ng into que stion ver y tig ht gly cemic con tro l goa ls in crit- ically ill patients. ● The section “Strategies for improving diabetes care” has been extensively revised to reflect newer evidence. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● DOI: 10.2337/dc10-S003 © 2010 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons. org/licenses/by-nc-nd/3.0/ for details. S U M M A R Y O F R E V I S I O N S care.diabetesjournals.org DIABETES CARE, VOLUME 33, SUPPLEMENT 1, JANUARY 2010 S3

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Summary of Revisions for the 2010Clinical Practice Recommendations

Beginning with the 2005 supple-ment, the Clinical Practice Recom-mendations contained only the

“Standards of Medical Care in Diabetes”and selected other position statements.This change was made to emphasize theimportance of the “Standards” as the bestsource to determine American Diabetes

Association recommendations. The posi-tion statements in the supplement are up-dated yearly. Position statements notincluded in the supplement will be up-dated as necessary and republished whenupdated. A list of the position statementsnot included in this supplement appearson p. S100.

Additions to the “Standards of

Medical Care in Diabetes”

● A section on cystic fibrosis–related dia-betes has been added.

Revisions to the “Standards of Medical Care in Diabetes”

In addition to many small changes relatedto new evidence since the previous ver-sion, the following sections have under-gone major changes:

● The section “Diagnosis of diabetes” hasbeen revised to include the use of A1Cto diagnose diabetes, with a cut point of 6.5%.

● The section previously titled “Diagnosisof pre-diabetes” has been renamed“Categories of increased risk for diabe-tes.” In addition to impaired fasting glu-cose and impaired glucose tolerance, an

A1C range of 5.7–6.4% has been in-cluded as a category of increased riskfor future diabetes.

● The section “Detection and diagnosis of GDM” has been revised to discuss po-tential future changes in the diagnosisbased on international consensus.

● The section “Diabetes self-managementeducation” has been extensively revisedto reflect new evidence.

● The section “Antiplatelet agents” hasbeen extensively revised to reflect re-cent trials questioning the benefit of as-pirinfor primary cardiovascular diseaseprevention in moderate- or low-riskpatients. The recommendation haschanged to consider aspirin therapy asa primary prevention strategy in thosewith diabetes at increased cardiovascu-lar risk (10-year risk 10%). This in-

cludes men50years of age or women60 years of age with at least one ad-ditional major risk factor.

● The section “Retinopathy screeningand treatment” has been updated toinclude a recommendation on use of fundus photography as a screeningstrategy.

● The section “Diabetes care in the hospi-tal” has been extensively revised to re-flect new evidence calling into questionvery tight glycemic control goals in crit-ically ill patients.

● The section “Strategies for improvingdiabetes care” has been extensively re-vised to reflect newer evidence.

● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

DOI: 10.2337/dc10-S003© 2010 by the American Diabetes Association. Readers may use this article as long as the work is properlycited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

S U M M A R Y O F R E V I S I O N S

care.diabetesjournals.org DIABETES CARE, VOLUME 33, SUPPLEMENT 1, JANUARY 2010 S3