Clinical Practice Recommendations… Says Who?

When I was first diagnosed with diabetes, my parents gave me a copy of the book, American Diabetes Association’s Complete Guide to Diabetes. It was the second edition back then (now the fourth edition is available), and while it was bursting with tons of information and advice, I didn’t think much about where that information and advice came from besides the fact that it was from the American Diabetes Association.

Similarly, although I always knew that the Association also works to develop and promote medical guidelines for health care professionals, I never stopped to consider the process by which the Association determines these medical guidelines. Do they evaluate clinical research? Collect advice from key opinion leaders? Build expert consensus groups? Or, perhaps, all of the above?

The answer is, as you might have guessed, “all of the above.”  In fact, the American Diabetes Association works with international medical and research communities to set the medical standards for diabetes care that guide health care teams in setting goals and helping people manage diabetes.

Why should I aim for an A1C lower than 7.0%? It’s based on loads of studies that have been collected, analyzed and discussed by the expert groups that volunteer with the Association.

Why did I start taking an ACE inhibitor when my microalbumin levels were more than 30? Loads of other studies, analyses and discussions!

Why do I have to get my eyes dilated when I see my eye doctor each year? Yup, you guessed it, tons of research that has been compiled, analyzed and discussed by the Association’s clinical practice committees.

That’s just the tip of the iceberg, however, as the committees go deeper and deeper into each topic for many different scenarios and factors such as coexisting conditions, allergies, risks, lifestyle, pregnancy, age, medical history, etc.

Every year in January, the Association publishes its Clinical Practice Recommendations in a supplement to the medical journal Diabetes Care. This year, the major change focused on the way that pregnant women (who don’t have diabetes) are tested for gestational diabetes. Because gestational diabetes can cause risks for both mother and child if undiagnosed and/or uncontrolled, one focus for the 2011 guidelines was to make sure that pregnant women are properly screened, diagnosed and treated for gestational diabetes.

Based on a multinational epidemiologic study, the new recommendations broadened the glucose range level by which gestational diabetes is defined and called for testing all pregnant women with risk factors for type 2 diabetes at their first neonatal visit, due to rising prevalence of undiagnosed type 2 diabetes in women of childbearing age (this would be diagnosed as type 2 diabetes, however, and not gestational diabetes).

Why do I get excited about this? These guidelines increase the opportunity for healthier mommies and healthier babies, of course! Also because it shows a different side to what the Association does – in addition to Step Out and Tour de Cure, in addition to funding diabetes research and advocating for the rights of those affected by diabetes, and in addition to answering the age-old question of “What Can I Eat?” – providing updated guidance to health care professionals is another big part of the Association’s mission. The 2011 Clinical Practice Recommendations also include two new sections – one that looks at Monogenic Forms of Diabetes (MODY) and another that addresses disengaging from the health care system, a problem often observed in older teens and young adults with diabetes.

Please note: The American Diabetes Association’s Clinical Practice Recommendations are written for clinicians who can assess both these recommendations and every individual’s health history and status. As always, we advise that you consult with your health care team before making any changes to your own diabetes management routine.

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