What are the recommended resources and treatment guidelines for learning about and managing diabetes?

Learning About Diabetes from High-Quality Literature

The American Diabetes Association's Standards of Medical Care in Diabetes, published annually in Diabetes Care, represents the gold standard resource for evidence-based diabetes management and should be your primary reference. 1

Essential Primary Resources

Core Guidelines

• The ADA Standards of Medical Care in Diabetes (updated annually) provides comprehensive, evidence-graded recommendations covering all aspects of diabetes diagnosis, treatment, and complication management. 1

• Access the complete guidelines at professional.diabetes.org/SOC, which includes detailed sections on lifestyle management, pharmacologic therapy, technology, and complication screening. 1

• The ADA Consumer Guide (consumerguide.diabetes.org) helps healthcare professionals and patients make informed decisions about diabetes devices and technologies. 1

Key Guideline Sections to Master

Lifestyle Management forms the foundation of all diabetes care and includes diabetes self-management education and support (DSMES), medical nutrition therapy (MNT), physical activity recommendations, and psychosocial care. 1

• DSMES improves A1C by 0.3-2% in type 2 diabetes and 1.0-1.9% in type 1 diabetes, reduces mortality risk, and lowers healthcare costs. 2
• All patients should receive DSMES at four critical times: at diagnosis, annually, when complications arise, and during care transitions. 1

Diabetes Technology guidelines cover continuous glucose monitoring (CGM), insulin pumps, automated insulin delivery systems, and connected insulin pens. 1

• CGM should be considered from the outset of insulin-requiring diabetes diagnosis, as early initiation decreases A1C and improves outcomes. 1
• Interruption of CGM access is associated with worsening outcomes, emphasizing the importance of consistent device access. 1

Stepwise Management Algorithm

Type 2 Diabetes Treatment Approach

Start metformin at or soon after diagnosis along with comprehensive lifestyle modifications (150 minutes weekly moderate-intensity aerobic activity plus resistance training twice weekly). 2, 3

• Metformin is preferred due to efficacy, safety, low cost, and potential cardiovascular benefits. 2, 3
• If established atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease exists, add a GLP-1 receptor agonist or SGLT2 inhibitor at diagnosis. 2, 4

Reassess medication regimens every 3-6 months and adjust based on A1C, side effects, and patient factors. 2

• Target A1C <7.0% for most adults, though individualize based on age, comorbidities, hypoglycemia risk, and life expectancy. 1, 3
• For patients ≥60 years without advanced complications, maintain <7.0% target; consider relaxing to <8.0% if age >65 with multiple comorbidities. 4

Type 1 Diabetes Management

Initiate multiple-dose insulin injections or continuous subcutaneous insulin infusion from diagnosis. 2

• Insulin analogues are preferred over regular insulin to reduce hypoglycemia risk. 2
• CGM significantly reduces severe hypoglycemia risk and should be implemented early. 2

Nutrition and Weight Management

No single ideal macronutrient distribution exists for all patients—individualize based on metabolic goals, preferences, and eating patterns. 1, 3

• Effective patterns include Mediterranean-style, DASH, plant-based, lower-fat, and lower-carbohydrate approaches. 3
• For overweight/obese patients, prescribe a 500-750 kcal/day energy deficit to achieve ≥5% weight loss. 1, 2, 3

Structured programs emphasizing lifestyle changes produce 5-7% weight loss and reduce diabetes risk. 1, 2

Cardiovascular Risk Management

Target blood pressure <130/80 mmHg for patients with diabetes. 1, 3

• Initiate ACE inhibitors or beta blockers as first-line agents. 3
• Reduce sodium intake to <2,400 mg (100 mmol) daily. 1

Manage dyslipidemia aggressively, limiting saturated fatty acids to <10% (preferably <7%) of energy intake. 1, 3

Complication Screening

Conduct annual comprehensive eye examinations, screen for diabetic kidney disease, and perform comprehensive foot examinations. 3

• For type 1 diabetes, begin microalbuminuria screening after 5 years of disease duration. 1
• Screen all type 2 diabetes patients for microalbuminuria at diagnosis. 1

Team-Based Care Structure

Diabetes care requires a multidisciplinary team including physicians, nurse practitioners, nurses, dietitians, pharmacists, and mental health professionals. 1, 3

• The Chronic Care Model provides an effective framework, emphasizing productive interactions between a prepared proactive care team and an informed activated patient. 1
• Implement shared decision-making to improve treatment adherence, patient satisfaction, and clinical outcomes. 3

Critical Safety Considerations

Severe or frequent hypoglycemia mandates immediate treatment regimen modification. 2

• Patients with hypoglycemia unawareness should increase glycemic targets for several weeks. 2
• Glucose (15-20 g) is the preferred treatment for hypoglycemia, with response expected in 10-20 minutes. 1

School Support for Students

Students require support for diabetes technology use at school, including CGM systems, insulin pumps, connected insulin pens, and automated insulin delivery systems. 1

• Instructions must be outlined in the student's diabetes medical management plan (DMMP) with backup plans for device failure. 1
• Updated resources and DMMP templates are available at diabetes.org/safeatschool. 1

Additional High-Quality Resources

The ADA/EASD consensus report on type 1 diabetes management in adults provides comprehensive guidance on diagnosis, treatment, and special populations. 5

National Diabetes Education Program resources (www.betterdiabetescare.nih.gov) help design and implement effective healthcare delivery systems. 1

Common Pitfalls to Avoid

Clinical inertia—delaying therapy intensification when glycemic targets are not met—is a major barrier to optimal outcomes. 4

• Do not overlook the importance of addressing all cardiovascular risk factors, not just glucose control. 4
• Avoid polypharmacy without clear benefit, especially in older adults. 4

Only use FDA-approved blood glucose meters with proven accuracy, with unexpired strips purchased from pharmacies or licensed distributors. 1