American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Visit NDEI.org for interactive summary

recommendations on the ADA 2014 guidelines.
Source: American Diabetes Association.
Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Diagnosis & A1C Testing
Criteria for Diabetes Diagnosis: 4 options
A1C 6.5%*
Perform in lab using NGSP-certified method and standardized to DCCT assay
FPG 126 mg/dL (7.0 mmol/L)*
Fasting defined as no caloric intake for 8 hrs
2-hr PG 200 mg/dL (11.1 mmol/L) during OGTT (75-g)*
Random PG 200 mg/dL (11.1 mmol/L)
In persons with symptoms of hyperglycemia or hyperglycemic crisis
*In the absence of unequivocal hyperglycemia results should be confirmed using repeat testing
Frequency of A1C Testing
Perform A1C test
At least 2 times each year
in patients who are meeting treatment
targets and have stable glycemic control

Quarterly
in patients whose therapy has changed
or who are not meeting glycemic targets

Point-of-care A1C testing allows for more timely treatment changes

DCCT=Diabetes Control and Complications Trial; FPG=fasting plasma glucose; OGTT=oral glucose tolerance test; PG=plasma glucose

See the end of this document for slides available

for download in the NDEI.org Slide Library.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Glycemic, BP, and Lipid Treatment Targets
Glycemic Targets for Adults With Diabetes
<7.0%
Lowering A1C below or around 7.0% shown to reduce
A1C

Microvascular complications
Macrovascular disease*

Preprandial capillary PG

70-130 mg/dL (3.9-7.2 mmol/L)

Peak postprandial capillary PG

<180 mg/dL (<10.0 mmol/L)

Postprandial glucose measurements should be made 1-2 h
after the beginning of the meal

Individualize targets based on:

Age/life expectancy
Comorbid conditions
Diabetes duration
Hypoglycemia status
Individual patient considerations
Known CVD/advanced microvascular complications

More or less stringent targets may be appropriate

if achieved without significant hypoglycemia or adverse events
More stringent (<6.5%)

Short diabetes duration

Long life expectancy
No significant CVD

Less stringent (<8%)

Severe hypoglycemia history

Limited life expectancy
Advanced microvascular or macrovascular
complications
Extensive comorbidities
Long-term diabetes in whom general A1C target
difficult to attain

Targets shown are for nonpregnant adults

*If implemented soon after diagnosis

Despite diabetes self-management, appropriate glucose monitoring, effective doses of

antihyperglycemic agents (including insulin)
Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Continued from previous page
Blood Pressure and Lipid Targets
Blood Pressure: <140/<80 mm Hg
Lower SBP targets may be appropriate based on individual patient characteristics
and therapeutic response
Lipids: LDL-C <100 mg/dL (<2.6 mmol/L)
A lower LDL-C target of <70 mg/dL, using a high dose of a statin,
may be appropriate in persons with overt CVD

CVD=cardiovascular disease; SBP=systolic blood pressure; PG=plasma glucose

Type 2 Diabetes Prevention

Prevention/Delay of Type 2 Diabetes
Patients with IGT, IFG, or A1C 5.7%-6.4%

Refer to ongoing support program targeting

Weight loss (7% of body weight)

Increased physical activity
(150 min/week moderate activity)

Consider metformin therapy for type 2 diabetes Especially in presence of

prevention in patients with IGT, IFG, or A1C
5.7%-6.4%
BMI >35 kg/m2
Age <60 years
Women with prior GDM
Annual monitoring of individuals with prediabetes
Screening for and treatment of modifiable CVD risk factors
(obesity, hypertension, and dyslipidemia) suggested
BMI=body mass index; CVD=cardiovascular disease; GDM=gestational diabetes mellitus; IFG=impaired fasting glucose;
IGT=impaired glucose tolerance

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Pharmacologic Therapy for Type 2 Diabetes

Medications for Hyperglycemia in Type 2 Diabetes
Metformin

Preferred initial therapy (if tolerated and not contraindicated)

Consider insulin therapy with

or without other agents

At outset in newly diagnosed patients with markedly

symptomatic and/or elevated blood glucose levels or A1C

Add 2nd oral agent, GLP-1

receptor agonist, or insulin

If noninsulin monotherapy at maximal tolerated dose does not

achieve or maintain A1C target over 3 mos

Choice of pharmacologic therapy should be based on patient-centered approach

Consider:

Efficacy
Cost
Potential side effects
Effects on weight
Comorbidities
Hypoglycemia risk
Patient preferences

Insulin eventually needed for many patients due to progressive nature of type 2 diabetes
GLP=glucagon-like peptide

Visit NDEI.org for summary recommendations on the

ADA/European Association for the Study of Diabetes (EASD) management
of hyperglycemia in type 2 diabetes guidelines.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Insulin & Glucose Monitoring
Self-Monitoring of Blood Glucose (SMBG)
Encourage for patients receiving multiple dose
insulin or insulin pump therapy:

Prior to meals and snacks

Occasionally postprandially
At bedtime
Prior to exercise
When low blood glucose is suspected
After treating low blood glucose until
normoglycemic
Prior to critical tasks (eg, driving)

Results may be useful for guiding treatment and/or self-management for patients using less frequent
insulin injections or noninsulin therapies

Provide ongoing instruction and regular evaluation of SMBG technique and results and
patients ability to use data to adjust therapy

Continuous Glucose Monitoring (CGM)

Useful for A1C lowering in select adults

(aged 25 yrs) with type 1 diabetes requiring
intensive insulin regimens

May be a useful supplement to SMBG among

patients with

May be useful among children, teens,

and younger adults*
Success related to adherence to
ongoing use
Hypoglycemia unawareness and/or
Frequent hypoglycemic episodes

*Evidence for A1C lowering less strong in these populations

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Cardiovascular Disease (CVD) & Diabetes
CVD Screening and Treatment
Screening

Asymptomatic patients: routine CAD screening not recommended; treatment of

CVD risk factors is focus
Overt CVD: consider ACEI, and use aspirin and statin to reduce CV event risk
Prior MI: continue use of beta-blockers for 2 yrs after event
Symptomatic heart failure: avoid TZDs
Metformin

Treatment

Stable heart failure: may use metformin in presence of normal renal

function
Avoid metformin in unstable or hospitalized heart failure patients

Management of High Blood Pressure

Screening

Measure BP at every visit; confirm elevated BP at separate visit

Treatment targets

Diabetes and hypertension: SBP <140 mm Hg

Lower SBP targets (eg, <130 mm Hg) may be appropriate*

Diabetes: DBP <80 mm Hg

BP >120/80 mm Hg: lifestyle changes

Treatment

Weight loss (if overweight)

DASH-style diet including sodium restriction, potassium increase
Moderate alcohol intake
Increased physical activity

BP >140/80 mm Hg: lifestyle changes + pharmacologic therapy

Treatment and targets

for pregnant women

Diabetes and hypertension: ACEI or ARB

2 agents at max doses usually required to achieve targets
Administer 1 agent at bedtime
ACEI, ARB, diuretic: monitor serum creatinine/eGFR and serum
potassium

Diabetes and hypertension: 110-129/65-79 mm Hg target

ACEI, ARB contraindicated

*In certain individuals, if achieved without treatment burden ; If one class not tolerated, substitute other class
Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source:
Source:American
AmericanDiabetes
DiabetesAssociation.
Association.
Standards
Standardsofofmedical
medicalcare
careinindiabetes2014.
diabetes2014.Diabetes
DiabetesCare.
Care.2014;37(suppl
2014;37(suppl1):S14-S80.
1):S14-S80.
Refer
to
source
document
for
full
recommendations,
including

Refer to source document for full recommendations, includinglevel

levelofofevidence
evidencerating.
rating.
Continued from previous page
Management of Dyslipidemia
Screening

Measure fasting lipids at least annually

Every 2 yrs for adults with low-risk lipid values: LDL-C <100 mg/dL
(2.6 mmol/L), HDL-C >50 mg/dL (1.3 mmol/L), TG <150 mg/dL (1.7 mmol/L)

Targets

No overt CVD: LDL-C <100 mg/dL (2.6 mmol/L)

Overt CVD: LDL-C <70 mg/dL (1.8 mmol/L), with high-dose statin*
If targets not achieved on max statin therapy: ~30-40% LDL-C
reduction from baseline

Lifestyle modification

Treatment

Reduce saturated fat, trans fat, cholesterol intake

Increase omega-3 fatty acids, viscous fiber, plant stenols/sterols
intake
Weight loss (if indicated)
Increase physical activity

Statin therapy* and lifestyle changes in patients with

Overt CVD
No CVD, aged >40 yrs, 1 CVD risk factor
Consider statins in lower-risk patients (no overt CVD, aged <40 yrs)
if LDL-C >100 mg/dL or if multiple CVD risk factors

Combination therapy not recommended

*Contraindicated in pregnancy

Hypertension, smoking, dyslipidemia, albuminuria, family history of CVD

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Source: American Diabetes Association.

Continued from previous page

Antiplatelet Therapy
75-162 mg/day: type 1 and type 2 diabetes at increased CVD risk
(10-yr risk >10%)*
Aspirin: Primary
prevention

Low-risk patients (10-yr risk <5%): not recommended; potential for

bleeds likely offsets potential benefits
Men <50 yrs, women <60 yrs with multiple other risk factors
(10-yr risk 5%-10%): use clinical judgment

Aspirin: Secondary
prevention

75-162 mg/day: diabetes and CVD history

CVD and aspirin allergy

Clopidogrel 75 mg/day

Dual antiplatelet therapy Reasonable for 1 year after ACS

*Includes most men aged >50 yrs or women aged >60 yrs with 1 addl major risk factor: family
history of CVD, hypertension, smoking, dyslipidemia, or albuminuria

Men aged <50 yrs and women aged >60 yrs with no major additional CVD risk factors
ACEI=angiotensin-converting enzyme inhibitor; ACS=acute coronary syndrome; ARB=angiotensin receptor blocker; BP=blood pressure;
CAD=coronary artery disease; CVD=cardiovascular disease; DASH=Dietary Approaches to Stop Hypertension; DBP=diastolic blood pressure;
eGFR=estimated glomerular filtration rate; MI=myocardial infarction; SBP=systolic blood pressure; TZD=thiazolidinedione

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Microvascular Complications
Nephropathy Screening and Treatment
Optimize glucose and BP control to reduce risk or slow progression of nephropathy
Screening

Annually measure urine albumin excretion in type 1 patients with 5-yr diabetes
duration, and all type 2 patients starting at diagnosis

Treatment

Normal BP and albumin excretion

<30 mg/24 h

ACEI or ARB for primary prevention of

kidney disease not recommended

Nonpregnant with modest elevations Use ACEI or ARB (but not in combination)
(30-299 mg/24 h) or higher levels
(300 mg/24 h) of urinary albumin
excretion
Diabetic kidney disease
(albuminuria >30 mg/24 h)

Limiting protein intake not recommended

When using ACEI, ARB, diuretic

Monitor creatinine and potassium levels

Monitor urine albumin excretion continually to assess therapeutic response,

disease progression
If eGFR <60 mL/min/1.73 m2

Evaluate, manage CKD complications

Consider specialist referral

Uncertainty re: kidney disease etiology,

difficult management issues, advanced
kidney disease

Retinopathy Screening and Treatment

Optimize glucose and BP control to reduce risk or slow progression of retinopathy
Screening Initial dilated and comprehensive eye exam by an ophthalmologist or optometrist

Adults with type 1 diabetes: within 5 yrs after diabetes onset

Patients with type 2 diabetes: shortly after diagnosis

If no retinopathy for 1 eye exam: consider exams every 2 yrs

If retinopathy: annual exam
Retinopathy progressing or sight threatening: more frequent exams

Fundus photographs: screening tool; not a substitute for comprehensive exam

Pregnant women or women planning pregnancy with preexisting diabetes

Retinopathy counseling, eye exam in first trimester

Close follow-up throughout pregnancy and 1 yr postpartum

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Continued from previous page
Treatment Macular edema, severe Refer to ophthalmologist specializing in retinopathy
NPDR, any PDR
Laser photocoagulation Indicated to reduce risk of vision loss for high-risk PDR,
therapy
clinically significant macular edema, some cases of severe
NPDR
Anti-VEGF therapy

Indicated for diabetic macular edema

Retinopathy not a contraindication to aspirin therapy for cardioprotection

Neuropathy Screening and Treatment

Screening

Screen all patients for distal symmetric polyneuropathy

Type 2 diabetes: at diagnosis

Type 1 diabetes: 5 yrs after diagnosis and at least annually thereafter

Electrophysiological testing or neurologist referral rarely needed except with

atypical clinical features
Screening for cardiovascular autonomic neuropathy

Treatment

Type 2 diabetes: at diagnosis

Type 1 diabetes: 5 yrs after diagnosis

Medications for relief of distal symmetric polyneuropathy and autonomic

neuropathy symptoms

ACEI=angiotensin-converting enzyme inhibitor; ARB=angiotensin receptor blocker; BP=blood pressure; CKD=chronic kidney disease;
eGFR=estimated glomerular filtration rate; NPDR=nonproliferative diabetic retinopathy; PDR=proliferative diabetic retinopathy; VEGF=vascular
endothelial growth factor

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

10

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Diabetes in Pregnancy (Gestational Diabetes)
Preconception Care
Maintain A1C levels as close to <7.0% as possible before attempting conception
All women of childbearing
potential
Evaluate and treat (if necessary)
in women contemplating
pregnancy

Evaluate, consider risk/benefit

profile of medications being
used for diabetes and
associated conditions prior to
conception

Provide preconception counseling starting at puberty

Retinopathy
Nephropathy
Neuropathy
CVD

Contraindicated/not recommended in pregnancy

Statins
ACEIs
ARBs
Most noninsulin therapies

Gestational Diabetes
Pregnant women with risk
factors

First prenatal visit: screen for undiagnosed type 2 diabetes using

standard criteria

Pregnant women without known Screen at 24-28 wks

prior diabetes
Women with GDM

Screen for persistent diabetes 6-12 wks postpartum using OGTT

and nonpregnancy diagnostic criteria

Women with GDM history and

prediabetes

Lifestyle interventions or metformin for diabetes prevention

Glycemic targets

Preprandial: 95 mg/dL (5.3 mmol/L) and either

1-h postmeal: 140 mg/dL (7.8 mmol/L) or
2-h postmeal: 120 mg/dL (6.7 mmol/L)

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

11

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

12

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Continued from previous page

Gestational Diabetes Screening and Diagnosis
No uniform approach for GDM diagnosis
Two options for women not previously diagnosed with overt diabetes:
One-Step (IADPSG)

75-g OGTT with PG measurement fasting

and at 1 h and 2 h, at 24-28 wks
Perform OGTT in am after overnight fast
(8 h)
GDM diagnosis made if PG values in
excess of
o Fasting: 92 mg/dL (5.1 mmol/L)
o 1 h: 180 mg/dL (10.0 mmol/L)
o 2 h: 153 mg/dL (8.5 mmol/L)

Two-Step (NIH)

50-g GLT (nonfasting) with PG

measurement at 1 h (Step 1),
at 24-28 wks
If PG at 1 h after load is 140 mg/dL*
(10.0 mmol/L), proceed to 100-g OGTT
(Step 2), performed while patient is
fasting
GDM diagnosis made when PG
measured 3 h post-test is 140 mg/dL
(7.8 mmol/L)

*Threshold of 135 mg/dL in high-risk ethnic minorities with higher prevalence of GDM recommended by ACOG
ACEI=angiotensin-converting enzyme inhibitor; ACOG=American College of Obstetricians and Gynecologists; ARB=angiotensin receptor blocker;
CVD=cardiovascular disease; GDM=gestational diabetes mellitus; GLT=glucose load test; IADPSG=International Association of Diabetes and
Pregnancy Study Groups; NIH=National Institutes of Health; OGTT=oral glucose tolerance test; PG=plasma glucose

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Lifestyle Changes
Medical Nutrition Therapy
Nutrition therapy for all patients with type 1 and type 2 diabetes

As part of overall treatment plan

Prediabetes or diabetes

Individualized medical nutrition therapy as needed to achieve

treatment targets, preferably provided by registered dietitian

Individuals at high risk for developing type 2 diabetes

Begin structured program
emphasizing lifestyle changes,
including

Moderate weight loss (7% body weight)

Regular physical activity (150 min/wk) with dietary
strategies, including reduced caloric and fat intake

Achieve dietary fiber intake of 14 g/1,000 kcal and whole grains 50% of grain intake

Visit NDEI.org for summary recommendations on the ADA nutrition guidelines.

Physical Activity
Adults with diabetes
Exercise programs should include

150 min/wk moderate-intensity aerobic activity (50%-70% max heart rate), spread over
3 days/wk with no more than 2 consecutive days without exercise
Resistance training 2 times/wk (in absence of contraindications)*

Evaluate patients for contraindications prohibiting certain types of exercise before recommending
exercise program
Consider age and previous level of physical activity
Children with diabetes, prediabetes
60 min physical activity/day
*Adults with type 2 diabetes

Eg, uncontrolled hypertension, severe autonomic or peripheral neuropathy, history of foot lesions,
unstable proliferative retinopathy
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

13

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Continued from previous page

Smoking Cessation
Advise patients with diabetes not to smoke or use tobacco products
Counsel on smoking prevention and cessation as part of routine care
Assess level of nicotine dependence
Offer pharmacologic therapy as appropriate

Risk Factors & Prediabetes

Categories of Increased Risk for Diabetes (Prediabetes)
Impaired Fasting Glucose (IFG)
FPG 100 mg/dL-125 mg/dL (5.6 mmol/L-6.9 mmol/L)
OR
Impaired Glucose Tolerance (IGT)
2-hr PG in 75-g OGTT 140 mg/dL-199 mg/dL (7.8 mmol/L-11.0 mmol/L)
OR
A1C 5.7%-6.4%
For all tests

Risk is continuous, extending below lower limit of range and

becoming disproportionately greater at higher ends of range

IFG and IGT

View as risk factors for diabetes and CVD

Criteria for Type 2 Diabetes, Prediabetes Testing in Asymptomatic Adults

Consider testing in all adults with BMI* 25 kg/m2 (overweight) and additional risk factors:

Physical inactivity
First-degree relative with diabetes High-risk race/ethnicity
Women who delivered a baby >9 lb or were diagnosed with GDM
HDL-C <35 mg/dL TG >250 mg/dL
Hypertension (140/90 mm Hg or on therapy)
A1C 5.7%, IGT, or IFG on previous testing
Conditions associated with insulin resistance: severe obesity, acanthosis nigricans, PCOS
CVD history

If no risk factors: begin testing no later than age 45

*At-risk BMI may be lower in some ethnic groups
If normal results: repeat testing in 3-yr intervals

More frequent testing depending on initial test results, risk factors

Prediabetes: test yearly

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

14

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Continued from previous page

Common Comorbidities Associated With Diabetes

Certain cancers (liver, pancreas, bladder, endometrium, breast, colon/rectum)*

Cognitive impairment
Depression
Dyslipidemia
Fatty liver disease
Fractures
Hearing impairment
Hypertension
Low testosterone (men)
Obesity
Obstructive sleep apnea
Periodontal disease

*Possibly only associated with type 2 diabetes

BMI=body mass index; CVD=cardiovascular disease; FPG=fasting plasma glucose; GDM=gestational diabetes mellitus;
HDL-C=high-density lipoprotein cholesterol; IFG=impaired fasting glucose; IGT=impaired glucose tolerance; OGTT=oral
glucose tolerance test; PCOS=polycystic ovarian syndrome; PG=plasma glucose; TG=triglycerides

Diabetes Self-Management Education and Support

Provide at diabetes diagnosis and as needed thereafter
Measure and monitor effectiveness of self-management and quality of life as part of overall care
Programs should

Address psychosocial issues

Provide education and support to persons with
prediabetes to encourage behaviors that may prevent or
delay diabetes onset

January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

15

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Hypoglycemia
At-risk patients

Ask about symptomatic and asymptomatic hypoglycemia at each encounter

Preferred treatment: glucose (15-20 g)*

After 15 mins of treatment, repeat if hypoglycemia continues (per SMBG)

When SMBG normal: patient should consume meal or snack to prevent recurrence

Prescribe glucagon if significant risk of severe hypoglycemia

Hypoglycemia
unawareness or
episode of severe
hypoglycemia
Low or declining
cognition

Reevaluate treatment regimen

Insulin-treated patients: raise glycemic targets for several weeks to
partially reverse hypoglycemia unawareness and reduce recurrence

Continually assess cognitive function with increased vigilance for

hypoglycemia

*Any form of glucose-containing carbohydrate can be used

SMBG=self-monitoring of blood glucose

Visit NDEI.org for summary recommendations on the ADA

and The Endocrine Society guidelines on hypoglycemia and diabetes.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

16

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Type 1 Diabetes
Insulin Therapy
Most patients with type 1 diabetes:

Treat with multiple-dose insulin injections

(3-4 injections/day of basal and prandial insulin) or
continuous subcutaneous insulin infusion
Educate on how to match prandial insulin dose to
carbohydrate intake, premeal blood glucose, and
anticipated activity
Use insulin analogs to reduce risk of hypoglycemia
Consider using sensor-augmented low glucose suspend
threshold pump in patients with frequent nocturnal
hypoglycemia and/or hypoglycemia unawareness

Most patients with type 1 diabetes: Consider screening for autoimmune diseases as appropriate

Thyroid dysfunction, vitamin B12 deficiency, celiac disease

Screening
Inform individuals with type 1 diabetes of the opportunity to have relatives screened for risk of type 1
diabetes in the clinical research setting

Early diagnosis may limit complications, extend long-term endogenous insulin production

Widespread testing of asymptomatic low-risk persons: not recommended

Screen high-risk persons only in clinical research setting

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

17

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Hospital Care (In-Patient)
Diabetes Care
Discharge planning

Begin at admission
Clear diabetes management instructions
provided at discharge

Sole use of sliding scale insulin in inpatient setting discouraged

All patients

Clearly document diabetes in medical record

Order blood glucose monitoring; results
available to healthcare team

Nondiabetic patients receiving therapy

associated with high hyperglycemia risk

Monitor glucose
Consider treating to same targets as patients
with known diabetes

Establish hypoglycemia management protocol and create a plan for each patient for treating and
preventing hypoglycemia

Document and track all hypoglycemia episodes

Consider A1C test for patients with

Diabetes if no test results from prior 2-3 mos

Risk factors for undiagnosed diabetes who
exhibit hyperglycemia

Patients with hyperglycemia, no prior

diabetes

Plan for follow-up testing and care documented

at discharge

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

18

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Continued from previous page
Glycemic Targets
Critically ill
patients

Persistent hyperglycemia:

Initiate insulin starting at 180 mg/dL (10.0 mmol/L)

Once insulin started, 140-180 mg/dL (7.8-10.0 mmol/L) recommended
glucose range for most patients

More stringent targets may be appropriate for certain patients providing no

increased hypoglycemia risk
IV insulin protocol with demonstrated efficacy, safety in achieving targets with no
increased hypoglycemia risk
Non-critically ill
patients

No clear evidence for specific glucose targets

Insulin-treated: premeal target <140 mg/dL (<7.8 mmol/L) with random blood
glucose <180 mg/dL (<10.0 mmol/L)
More or less stringent targets may be appropriate

More stringent: stable patients with previous tight glycemic control

Less stringent: severe comorbidities

Preferred method for achieving/maintaining glucose control: scheduled

subcutaneous insulin with basal, nutritional, correction components

Bariatric Surgery in Type 2 Diabetes

Consider for adults with In particular, if diabetes or associated comorbidities difficult to control with
lifestyle and pharmacologic therapy
BMI >35 kg/m2
Lifelong lifestyle support, medical monitoring necessary post-surgery
Insufficient evidence to recommend surgery with BMI <35 kg/m2 outside of a research protocol
BMI=body mass index

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

19

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Foot Care
All patients with diabetes

Patients with foot ulcers, high-risk feet

(previous ulcer or amputation)
Refer to foot care specialist

Annual foot exam to identify risk factors

predictive of ulcers and amputations
Exam to include: inspection, assessment of
foot pulses, LOPS testing
Provide foot self-care education

Use multidisciplinary approach

People who smoke

LOPS and structural abnormalities
History of prior lower-extremity complications
Lifelong surveillance

Include in initial PAD screening

Refer for further vascular assessment

History for claudication and assessment of

pedal pulses
Obtain ABI
Patients with positive ABI, significant
claudication
Consider exercise, medications, surgical
options

ABI=ankle-brachial index; LOPS=loss of protective sensation; PAD=peripheral arterial disease

January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

20

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Vaccination & Immunization
Influenza vaccine
Pneumococcal
polysaccharide vaccine

Annually in all patients with diabetes aged 6 mos

All patients with diabetes aged 2 yrs

Aged >65 yrs: one-time revaccination if vaccine administered

>5 yrs prior
Repeat vaccination for those with nephrotic syndrome, chronic
renal disease, other immunocompromised states

Hepatitis B vaccine

Unvaccinated adults with diabetes aged 19-59 yrs

Consider in unvaccinated adults aged 60 yrs

Psychosocial Considerations
Reasonable to include psychological and social assessments of patient as part of
diabetes management
Psychosocial screening and follow-up may
include:

Attitudes about diabetes

Expectations for medical management and
outcomes
Mood
Quality of life
Financial, social, emotional resources
Psychiatric history

Screen on routine basis for depression and diabetes-related distress, anxiety, eating disorders, and
cognitive impairment

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

21

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Diabetes Care in Older Adults
Older adults who are

Same treatment goals as younger adults

Functional
Cognitively intact
Expected to live long
enough to reap benefits

Glycemic targets: may be relaxed for some older adults based on individual criteria

Avoid hyperglycemic complications

Treat CV risk factors considering

Timeframe of benefit, individual patient characteristics

Hypertension treatment indicated in many older adults
Lipid, aspirin therapy may benefit patients whose life
expectancy is equal to timeframe of primary or secondary
prevention trials

Individualize screening for complications

Be mindful of complications that may lead to functional impairment

Cystic Fibrosis-Related Diabetes

Screening

Annually using OGTT

Begin by age 10 in patients with cystic fibrosis who do not
have CFRD
A1C not recommended as screening test

Diagnosis

Use usual glucose criteria during period of stable health

Treatment

Use insulin to achieve individualized glycemic targets

Monitoring for diabetes

complications

Annually; start 5 yrs post-CFRD diagnosis

CFRD=cystic fibrosis-related diabetes; OGTT=oral glucose tolerance test

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

22

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Children & Adolescents
Type 2 Diabetes in Children & Adolescents
Screening for Type 2 Diabetes and Prediabetes
Consider for all children who are overweight* and have 2 of any of the following risk factors:

Family history of type 2 diabetes in first- or second-degree relative

Race/ethnicity
Signs of insulin resistance or conditions associated with insulin resistance
Maternal history of diabetes or GDM during childs gestation
Begin testing at age 10 yrs or onset of puberty
Test every 3 yrs
A1C test recommended for diagnosis in children and adolescents
At Diagnosis

Perform eye exam

Measure risk factors
o Blood pressure
o Fasting lipids
o Albumin excretion

After Diagnosis
Similar screening, treatment as for type 1 diabetes
for

Hypertension
Albumin excretion
Dyslipidemia
Retinopathy

Other issues that may need to be addressed:

polycystic ovarian disease, other pediatric obesity comorbidities
Children: age 18 yrs
*BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% ideal for height

Native American, African American, Latino, Asian American, Pacific Islander

Acanthosis nigricans, hypertension, dyslipidemia, PCOS, or small-for-gestational-age birth weight

Sleep apnea, hepatic steatosis, orthopedic complications, psychosocial concerns

Visit NDEI.org for summary recommendations on the American Academy of Pediatrics,

Pediatric Endocrine Society, American Academy of Family Physicians,
ADA, and Academy of Nutrition and Dietetics guidelines on
managing newly diagnosed type 2 diabetes in children and adolescents.

January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

23

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

24

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
Type 1 Diabetes in Children & Adolescents
Glycemic Targets
Consider risk-benefit assessment, including hypoglycemia risk,
when individualizing targets*
0-6 yrs

6-12 yrs

13-19 yrs

<8.5%

<8%

<7.5%

PG: prior to meals

100-180 mg/dL

90-180 mg/dL

90-130 mg/dL

PG: bedtime & overnight

110-200 mg/dL

100-180 mg/dL

90-150 mg/dL

A1C

*If on basal-bolus: measure postprandial PG to monitor glycemic values and if discrepancy between
preprandial PG and A1C; modification of targets may be needed in children aged <7 yrs due to
hypoglycemic unawareness; Reasonable to consider lower target if achieved in absence of
excessive hypoglycemia
Microvascular Complications in Children & Adolescents With Type 1 Diabetes
Nephropathy
Screening

Aged 10 yrs or puberty onset (whichever occurs first) with 5-yr diabetes duration

Treatment

Albumin levels: yearly

ACR: random urine sample

ACEI titrated to normalization of albumin excretion

If elevated ACR confirmed over 6 mos, after efforts to control glucose,

normalize BP

Retinopathy
Screening

Follow-up

Initial dilated and comprehensive eye exam

Aged 10 yrs or puberty onset (whichever occurs first) with 3-5yr diabetes
duration

Yearly
Less frequently: per recommendation of eye care professional

ACEIs are not approved by the U.S. Food and Drug Administration (FDA) for treatment of
nephropathy. Not all ACEIs are indicated for use in children/adolescents by the FDA. Refer to full
prescribing information for indications and uses in pediatric populations.
Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.
High Blood Pressure in Children & Adolescents With Type 1 Diabetes
Screening

Measure BP at every visit

Confirm elevated BP at separate visit

Treatment SBP or DBP >90th percentile*

Lifestyle changes (diet & exercise)

If target BP not met in 3-6 mos

Pharmacologic therapy
ACEI: initial treatment

SBP or DBP >95th percentile* or >130/80 mm Hg

Target: <130/80 mm Hg or <90th percentile*

*For age, sex, height; Provide counseling re: potential teratogenic effects.
Not all ACEIs are indicated for use in children/adolescents by the U.S. Food and Drug
Administration (FDA). Refer to full prescribing information for indications and uses in pediatric
populations.
Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

25

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Dyslipidemia in Children & Adolescents With Type 1 Diabetes

Screening

Obtain fasting lipids

Family history

CV event aged <55 yrs or

hypercholesterolemia

Aged >2 yrs

post-diagnosis*

Unknown
Unremarkable
Diabetes diagnosed prior to/post-puberty

Aged 10 yrs
Post-diagnosis*

Lipid monitoring: all patients

Treatment

If lipids abnormal: yearly

LDL-C <100 mg/dL (<2.6 mmol/L): every 5 yrs

Initial

Control glucose
MNT: decrease saturated fat intake

Aged 10 yrs

Lifestyle changes and MNT

After lifestyle changes, add statin if LDL-C
>160 mg/dL (>4.1 mmol/L) or >130 mg/dL
(>3.4 mmol/L) + 1 CVD risk factor

Target: LDL-C <100 mg/dL (<2.6 mmol/L)

*When glucose levels well controlled

Use American Heart Association Step 2 diet: saturated fat 7% of total calories; dietary cholesterol
200 mg/d

Statins are approved by the U.S. Food and Drug Administration for treatment of heterozygous
familial hypercholesterolemia in children and adolescents. Not all statins are FDA approved for use
under the age of 10 yrs; statins should generally not be used in children with type 1 diabetes before
age 10. Refer to full prescribing information for indications and uses in pediatric populations. For
postpubertal girls, pregnancy prevention is important as statins are contraindicated in pregnancy.
Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

26

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Screening for Comorbidities in Children & Adolescents With Type 1 Diabetes

Hypothyroidism
Post-diagnosis of type 1 diabetes
consider

Screening for

Antithyroid peroxidase antibodies

Antithyroglobulin antibodies

Measuring TSH*

Reassess every 1-2 yrs if normal

Post-diagnosis of type 1 diabetes

consider measuring

IgA antitissue transglutaminase

Antiendomysial antibodies

Candidates for testing

Family history of celiac disease

Failure to grow or gain weight
Weight loss
Diarrhea or flatulence
Abdominal pain
Signs of malabsorption
Repeated hypoglycemia of unknown cause or decline
in glycemic control

Celiac disease

Asymptomatic with
positive antibodies

Gastroenterologist referral for confirmatory endoscopy

and biopsy

If diagnosis confirmed

Gluten-free diet; dietitian consultation

*When metabolic levels well controlled

January 2014
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promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

27

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Monogenic Diabetes Syndromes in Children & Adolescents

Neonatal diabetes Maturity-onset diabetes of the young
Consider if:

Diabetes diagnosed within first 6 mos after birth

Strong diabetes family history; no typical features of type 2 diabetes
Mild fasting hyperglycemia,* esp if young and nonobese
Diabetes with negative autoantibodies, no signs of obesity or insulin resistance

*100-150 mg/dL (5.5-8.5 mmol/L)

ACEI=angiotensin-converting enzyme inhibitor; ACR=albumin-to-creatinine ratio; AHA=American Heart Association; BMI=body mass index;
BP=blood pressure; CV=cardiovascular; CVD=cardiovascular disease; GDM=gestational diabetes mellitus; MNT=medical nutrition therapy;
PCOS=polycystic ovarian syndrome; PG=plasma glucose; TSH=thyroid-stimulating hormone
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

All slides on the following pages

available for download
in the NDEI.org Slide Library.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

28

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

29

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

30

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations,

including level of evidence rating.

January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

31

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

32

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

33

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations, including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

34

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations, including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

35

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations, including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

36

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations, including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

37

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations,

including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

38

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations,

including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

39

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations, including level of evidence rating.

January 2014

This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

40

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

41

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

January 2014

This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

42

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations,

including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

43

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations, including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

44

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations,

including level of evidence rating.

January 2014

This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

45

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

46

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations,

including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

47

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations,

including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

48

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations,

including level of evidence rating.

January 2014

This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

49

Source: American Diabetes Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.
Refer to source document for full recommendations, including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

50

Source: American Diabetes

Association.

Standards of medical care in diabetes2014. Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations, including level of evidence rating.

Any pharmacologic agents discussed are approved for use in the United States by the U.S. Food and Drug Administration (FDA)
unless otherwise noted. Consult individual prescribing information for approved uses outside of the United States.
January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.

American Diabetes Association (ADA) 2014 Guidelines

Summary Recommendations from NDEI

51

Source: American
Diabetes Association.
Standards of medical care in diabetes2014.
Diabetes Care. 2014;37(suppl 1):S14-S80.

Refer to source document for full recommendations, including level of evidence rating.

January 2014
This content was created by KnowledgePoint360 Group, LLC, and was not associated with funding via an educational grant or a
promotional/commercial interest.

Sponsored by KnowledgePoint360 Group, LLC, Lyndhurst, NJ.

Copyright 2014 KnowledgePoint360 Group, LLC. All rights reserved.