Standards of medical care for diabetes mellitus

This brief report summarizes the key points of the new standards of medical care for patients with diabetes mellitus, adopted by the American Diabetes Association (ADA) in March 1994, a revision of the initial standards of October 1988. The standards apply primarily to patients with insulin-dependent diabetes mellitus, but the ADA recommends the same standards be applied to patients with noninsulin-dependent diabetes mellitus, with emphasis on diet and exercise, supplemented when indicated by oral drugs or insulin. Preprandial blood glucose should be below 80 mg/dL, and glycated hemoglobin should be less than 7%. This requires self-glucose-monitoring 3 or 4 times a day, patient-initiated insulin dosage changes, and other problem solving as needed, with support by a clinical team involving physicians, dietitians, diabetes educators, eye doctors, podiatrist, and other professionals. Glycated hemoglobin should be checked quarterly in all insulin-treated patients (and as needed in others). Microalbuminuria should be tested annually.