Standards of Medical Care in Diabetes2007AMERICANDIABETESASSOCIATIONCONTENTSI. CLASSIFICATION AND DIAGNOSIS, p. S4A. Classification B. DiagnosisII. SCREENING FOR DIABETES, p. S5III. DETECTION AND DIAGNOSIS OF GESTATIONAL DIABETES MELLITUS, p. S7IV. PREVENTION/DELAY OF TYPE 2 DIABETES, p. S7V. DIABETES CARE, p. S8 A. Initial evaluation B. Management C. Glycemic control 1. Assessment of glycemic control a. Self-monitoring of blood glucose b. A1C 2. Glycemic goals 3. Approach to treatment D. Medical nutrition therapy E. Diabetesself-managementeducation F. Physical activity G. Psychosocialassessmentandcare H. Referralfordiabetesmanagement I. Intercurrent illness J. Hypoglycemia K. ImmunizationVI. PREVENTION AND MANAGEMENT OF DIABETES COMPLICATIONS, p. S15 A. Cardiovascular disease 1. Hypertension/blood pressure control2. Dyslipidemia/lipid manage- ment 3. Antiplatelet agents 4. Smoking cessation 5. Coronary heart disease screening and treatment B. Nephropathy screening and treatment C. Retinopathy screening and treatment D. Neuropathy E. Foot careVII. DIABETES CARE IN SPECIFIC POPU- LATIONS, p. S24 A. Children and adolescents B. Preconception care C. Older individualsVIII. DIABETES CARE IN SPECIFIC SETTINGS, p. S27 A. Diabetes care in the hospital B. Diabetes care in the school and day care setting C. Diabetes care at diabetes camps D. Diabetes care at correctional institutions E. Emergency and disaster prepared- nessIX. HYPOGLYCEMIA AND EMPLOY- MENT/LICENSURE, p. S33X. THIRD-PARTY REIMBURSEMENT FORDIABETESCARE,SELF- MANAGEMENT EDUCATION, AND SUPPLIES, p. S33XI. STRATEGIES FOR IMPROVING DIA- BETES CARE, p. S33Diabetes is a chronic illness that re- quires continuing medical care and patient self-management education to prevent acute complications and to re- duce the risk of long-term complications. Diabetescareiscomplexandrequiresthat many issues, beyond glycemic control, be addressed.Alargebodyofevidenceexists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, research- ers, payors, and other interested individ- uals with the components of diabetes care, treatment goals, and tools to evalu- ate the quality of care. While individual preferences, comorbidities, and other pa-tient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to pre- clude more extensive evaluation and management of the patient by other spe- cialists as needed. For more detailed in- formation, refer to refs. 13. The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect healthoutcomesofpatientswithdiabetes. A grading system (Table 1), developed by theAmericanDiabetesAssociation(ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommenda- tions. The level of evidence that supports each recommendation is listed after each recommendationusingthelettersA,B,C, or E.I. CLASSIFICATION AND DIAGNOSISA. Classification In 1997, ADA issued new diagnostic andclassification criteria (4); in 2003, modi-ficationsweremaderegardingthediagno- sis of impaired fasting glucose (IFG) (5).The classification of diabetes includes four clinical classes:Type 1 diabetes (results from ?-cell de- struction, usually leading to absoluteinsulin deficiency) Type2diabetes(resultsfromaprogres- sive insulin secretory defect on the background of insulin resistance) Other specific types of diabetes due to other causes, e.g., genetic defects in The recommendations in this article are based on the evidence reviewed in the following publication: Standards of care for diabetes (Technical Review). Diabetes Care 17:15141522, 1994. Originally approved 1988. Most recent review/revision, October 2006. Abbreviations: ABI, ankle-brachial index; AMI, acute myocardial infarction; ARB, angiotensin receptor blocker; CAD, coronary artery disease; CBG, capillary blood glucose; CHD, coronary heart disease; CHF, congestive heart failure; CKD, chronic kidney disease; CMS, Centers for Medicare and Medicaid Services; CSII, continuous subcutaneous insulin infusion; CVD, cardiovascular disease; DCCB, dihydropyridine calcium channel blocker; DCCT, Diabetes Control and Complications Trial; DKA, diabetic ketoacidosis; DMMP, diabetes medical management plan; DPN, distal symmetric polyneuropathy; DPP, Diabetes Preven- tion Program; DRI, dietary reference intake; DRS, Diabetic Retinopathy Study; DSME, diabetes self- management education; DSMT, diabetes self-management training; ECG, electrocardiogram; ESRD, end- stage renal disease; ETDRS, Early Treatment Diabetic Retinopathy Study; FDA, Food and DrugAdministration; FPG, fasting plasma glucose; GDM, gestational diabetes mellitus; GFR, glomerular filtration