The updated Standards of Medical Care in Diabetes 2022, by the American Diabetes Association (ADA), states that:

For Improving Care and Promoting Health in Populations 

• Early treatment decisions must be made based on evidence-based guidelines.
• A customized, multidisciplinary approach to diabetes management addressing individual patient characteristics and the chronicity of the disease is advocated. This must include long-term treatment plans that focus on the prevention of the associated comorbidities.
• Physicians and healthcare personnel teams engaged in managing patients with diabetes should collaborate with and involve those who have knowledge and experience in this field. Support tools and community involvement may be utilized to meet patients’ needs.Suggested

Strategies for System-level Improvement are:

• Engaging multidisciplinary care teams
• Telemedicine
• Modifying patients’ lifestyle and behavior for improving disease prognosis

Immunization

Routine vaccinations are of utmost importance, particularly in the face of the ongoing coronavirus disease 2019 (COVID-19) pandemic and the newer emerging pathogens. Children, adults, and the elderly with diabetes should be immunized appropriately, according to recommendations.

Cancer

Cancer screening should be mandated for all patients with diabetes – as per their age and gender. Certain risk factors predisposing to cancer can be modified if detected early, for example – obesity, sedentary lifestyle, and tobacco use.

Goals of Nutrition Therapy 

• Patients should be made aware of and encouraged to follow healthy eating patterns. Nutrient-dense foods in age-appropriate proportions should be advised for attaining the glycemic, blood pressure, and lipid goals, as well as optimizing body weight and preventing diabetes-related complications.
• Address individual food habits, nutritional requirements, and access to healthy foods. 
• Limit food choices only when indicated.
• Suggest practical measures for adapting to healthy eating patterns and behavioral changes that are beneficial for managing diabetes.

Weight Management

Numerous dietary plans have been proposed––that are safe for patients with diabetes and aid in achieving weight loss. Individuals should be guided to choose a meal plan that comprises nutrient-dense foods – which can fulfill their energy requirements.

Assessment of Glycemic Control

• In patients with stable glycemic control who meet treatment goals, the glycemic status must be assessed at least twice a year.
• In patients with diabetes whose therapy has recently been altered and those who are unable to meet the glycemic goals, the glycemic status must be assessed at least quarterly and as needed.

Glycemic Goals 

• For non-pregnant women, an HbA1c goal of <7% is appropriate––as long as the anti-diabetic therapy does not impose a significant risk for hypoglycemia.
• Based on the physician’s judgment, achieving a lower HbA1c level below 7% may be acceptable and may provide benefits if attained safely – without significant hypoglycemia.
• For patients with limited life expectancy, more lenient HbA1c goals may be acceptable.

Source: Clinical Diabetes. 2022 Jan;40(1):10-38. DOI: 10.2337/cd22-as01.