American Diabetes Association’s Standards of Care: A Paradigm Shift in the Dissemination of Information

It is well understood that diabetes is a complex, chronic illness in which glycemic control reduces the development and progression of macrovascular and microvascular complications. Achieving risk reduction requires continuous medical care and self-management, with multifactorial risk-management strategies beyond just glycemic control, including lifestyle changes and cardiovascular risk reduction. Given the current knowledge of what is required to reduce complications, improve quality of life, and prevent progression to overt disease states, it is important that providers caring for people with diabetes have the latest and most updated clinical translation of the evidence as they consider the day-to-day management of their patients. In this regard, the American Diabetes Association (ADA) has been actively involved in the development and dissemination of diabetes care standards, guidelines, and related documents to support and improve patient care for over 25 years. Specifically, the ADA’s “Standards of Medical Care in Diabetes,” referred to as the Standards of Care, has always been intended to provide clinicians, patients, researchers, payers, and other interested individuals with evidence-based information on all aspects of diabetes care, general treatment goals, and tools to evaluate the quality of care (1). The recent acceleration of the pace of new information being released regarding diabetes care and research has been startling. To put this in perspective, the first ADA Standards of Care, published in 1989, provided recommendations based on the available evidence at that time and filled only four pages in Diabetes Care (2). In the most recent update, 28 years later, the document is well over 170 pages! Over 40 new type 2 diabetes treatment options have been approved since 2005 (3), not even counting advances in technology, such as continuous glucose monitoring. In the last year alone, there have been many significant changes to the Standards of Care, and the 2018 version …