ada 1 Flashcards
What is the purpose of the American Diabetes Association’s Standards of Care?
To provide clinicians and researchers with recommendations for the management of diabetes and its associated complications.
Who is the target audience for the Standards of Care?
Clinicians, researchers, and healthcare professionals.
Who is the target audience for the Standards of Care?
Clinicians, researchers, and healthcare professionals.
Who is the target audience for the Standards of Care?
Clinicians, researchers, and healthcare professionals.
What age groups do the recommendations in the Standards of Care cover?
Youth (birth to 11 years), adolescents (12-17 years), adults (18-64 years), and older adults (65 years and above).
What age groups do the recommendations in the Standards of Care cover?
Youth (birth to 11 years), adolescents (12-17 years), adults (18-64 years), and older adults (65 years and above).
Describe the scope of the Standards of Care.
The Standards of Care covers the prevention, screening, diagnosis, and management of diabetes and its associated complications and comorbidities.
What is the role of diabetes self-management education and support according to the Standards of Care?
It is critical in empowering individuals with diabetes, preventing acute complications, and reducing the risk of long-term complications.
What is the role of diabetes self-management education and support according to the Standards of Care?
It is critical in empowering individuals with diabetes, preventing acute complications, and reducing the risk of long-term complications.
Where can more information on the ‘Living Standards’ be found?
On the ADA professional website DiabetesPro at professional.diabetes.org/content-page/living-standards.
What types of diabetes does the Standards of Care cover?
Type 1 diabetes, type 2 diabetes, gestational diabetes mellitus, and other types of diabetes.
What is the recommended approach for improving diabetes outcomes according to the Standards of Care?
There is significant evidence supporting a range of interventions to improve diabetes outcomes.
What is the target audience for the Standards of Care?
Primary care physicians, endocrinologists, nurse practitioners, pharmacists, dietitians, and diabetes care and education specialists.
Describe the purpose of the Standards of Care.
To provide guidance and recommendations for the management of diabetes and its complications.
What healthcare professionals are included in the target audience for the Standards of Care?
Cardiologists, nephrologists, emergency physicians, internists, pediatricians, psychologists, neurologists, ophthalmologists, and podiatrists.
How are potential conflicts of interest evaluated during the appointment process?
They are evaluated by a designated review group and, if necessary, the Legal Affairs Division of the ADA.
Define the role of diabetes care and education specialists in diabetes management.
They provide specialized care, education, and support for individuals with diabetes.
What is the ADA evidence-grading system for Standards of Care in Diabetes?
Table 1-ADA evidence-grading system for Standards of Care in Diabetes
How are systematic literature searches conducted for the Standards of Care in Diabetes?
Each subcommittee devises and executes systematic literature searches
Describe the level of evidence A in the ADA evidence-grading system.
Clear evidence from well-conducted, generalizable randomized controlled trials
What is the level of evidence B in the ADA evidence-grading system?
Supportive evidence from well-conducted cohort studies
Define level of evidence C in the ADA evidence-grading system.
Supportive evidence from poorly controlled or uncontrolled studies
Define level of evidence C in the ADA evidence-grading system.
Supportive evidence from poorly controlled or uncontrolled studies
Define level of evidence C in the ADA evidence-grading system.
Supportive evidence from poorly controlled or uncontrolled studies
What does level of evidence E represent in the ADA evidence-grading system?
Expert consensus or clinical experience
What does level of evidence E represent in the ADA evidence-grading system?
Expert consensus or clinical experience
What does level of evidence E represent in the ADA evidence-grading system?
Expert consensus or clinical experience
How are the final evidence summaries and recommendations for the Standards of Care in Diabetes developed?
All PPC members discuss and review the evidence summaries and make revisions as appropriate
What is the revision process for the Standards of Care in Diabetes?
The final evidence summaries are deliberated on by the PPC, and the recommendations are drafted
What is a consensus report?
A consensus report represents expert opinion and is produced under the auspices of the ADA by invited experts.
Describe a scientific review.
A scientific review is a balanced review and analysis of the literature on a scientific or medical topic related to diabetes.
What is the purpose of ADA Statements, Consensus Reports, and Scientific Reviews?
They support the recommendations included in the ADA Standards of Care and provide a scientific rationale for clinical practice recommendations.
Who develops the ADA Standards of Care?
The ADA develops the Standards of Care and it is an essential resource for healthcare professionals caring for people with diabetes.
Who develops the ADA Standards of Care?
The ADA develops the Standards of Care and it is an essential resource for healthcare professionals caring for people with diabetes.
Who develops the ADA Standards of Care?
The ADA develops the Standards of Care and it is an essential resource for healthcare professionals caring for people with diabetes.
What does the annual Standards of Care supplement to Diabetes Care contain?
It contains the official ADA position and provides all of the ADA’s current clinical practice recommendations.
Who authors the annual Standards of Care supplement to Diabetes Care?
The ADA authors the supplement and it contains the official ADA position.
What is the role of the ADA in developing diabetes care clinical practice recommendations?
The ADA has been actively involved in developing and disseminating diabetes care clinical practice recommendations for more than 30 years.
What is the role of the ADA in developing diabetes care clinical practice recommendations?
The ADA has been actively involved in developing and disseminating diabetes care clinical practice recommendations for more than 30 years.
Describe the purpose of a scientific review.
A scientific review provides a balanced review and analysis of the literature on a scientific or medical topic related to diabetes.
Describe the general changes made in the 2023 Standards of Care.
The 2023 Standards of Care include revisions to incorporate person-first and inclusive language, as well as additional language and definitions regarding digital health, telehealth, and telemedicine.
What is the recommendation added in Section 1 regarding A1C testing?
Recommendation 2.1b was added to address the utility of point-of-care A1C testing for diabetes screening and diagnosis.
How does the 2023 Standards of Care address the use of community health workers?
Recommendation 1.7 was added to address the use of community health workers to support the management of diabetes and cardiovascular risk factors, especially in underserved communities and health care systems.
Define telehealth and telemedicine in the context of the 2023 Standards of Care.
Telehealth and telemedicine are modalities of care delivery that are discussed in the 2023 Standards of Care, highlighting their benefits and the role they play in addressing social determinants of health.
What was added to Section 5 of the Diabetes Care Volume 46, Supplement 1?
Recommendation 3.13
What changes were made to the title of the content?
It was changed to be inclusive of strength-based language
What was added to the Diabetes Self-Management Education and Support subsection?
Addressing social determinants of health
What changes were made in the immunizations subsection?
Reflecting new indications and guidance, particularly for COVID-19 and pneumococcal pneumonia vaccinations
What was added to Recommendation 6.5b in the Glycemic Targets section?
Outline for those with frailty or at high risk of hypoglycemia
What was added to the nutrition section?
Screening for food insecurity by any members of the health care team
What section incorporates more information on Nonalcoholic Fatty Liver Disease (NAFLD)?
The subsection on NAFLD
What was included in the ‘Eating Patterns and Meal Plan’ section?
A section on intermittent fasting and time-restricted eating
What is the recommended LDL cholesterol goal for individuals with diabetes and established atherosclerotic cardiovascular disease?
The recommended LDL cholesterol goal is a reduction of 50% from baseline and an LDL cholesterol goal of mg/dL.
What is the recommended LDL cholesterol goal for individuals with diabetes and established atherosclerotic cardiovascular disease?
The recommended LDL cholesterol goal is a reduction of 50% from baseline and an LDL cholesterol goal of mg/dL.
What is the recommended LDL cholesterol goal for individuals with diabetes and established atherosclerotic cardiovascular disease?
The recommended LDL cholesterol goal is a reduction of 50% from baseline and an LDL cholesterol goal of mg/dL.
Describe the benefits of early initiation of real-time CGM in children and adults with diabetes.
Early initiation of real-time CGM in children and adults with diabetes has been shown to have benefits on glycemic outcomes.
What is the recommendation for weight management in individuals with type 2 diabetes?
Weight management is recommended as an impactful component of glucose-lowering management in type 2 diabetes.
How should the treatment plan for individuals with diabetes and chronic kidney disease or atherosclerotic cardiovascular disease be approached?
The treatment plan should include agents that reduce cardiorenal risk and factors, aiming to reduce LDL cholesterol by 50% of baseline.
How should the treatment plan for individuals with diabetes and chronic kidney disease or atherosclerotic cardiovascular disease be approached?
The treatment plan should include agents that reduce cardiorenal risk and factors, aiming to reduce LDL cholesterol by 50% of baseline.
Define connected pens and their role in diabetes management.
Connected pens are pens that can be paired with smart pen caps or other devices to provide additional features and data for diabetes management.
Describe the revisions made to Recommendation 12.20 in the Chronic Kidney Disease section.
The recommendation was revised to reflect the use of gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers as initial pharmacologic treatments for neuropathic pain in diabetes.
Describe the revisions made to Recommendation 12.20 in the Chronic Kidney Disease section.
The recommendation was revised to reflect the use of gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers as initial pharmacologic treatments for neuropathic pain in diabetes.
What is the new recommendation added for older adults with type 1 diabetes in Recommendation 13.7?
The new recommendation suggests considering the use of automated insulin delivery systems and other advanced insulin delivery devices, such as connected pens, to reduce the risk of hypoglycemia.
What changes were made to the levels for initiation of a sodium-glucose cotransporter 2 inhibitor in Recommendation 11.5a?
The levels for initiation were changed to an estimated glomerular filtration rate of 20 mL/min/1.73 and urinary albumin of 200 mg/g creatinine.
Describe the expanded discussion in the ‘Neuropathic Pain’ subsection regarding treating neuropathic pain in people with diabetes.
The expanded discussion addresses lipid control and blood pressure control as part of the treatment for neuropathic pain in people with diabetes.
What is the new recommendation added in Recommendation 12.25?
Recommendation 12.25 addresses screening for peripheral arterial disease.
What was Recommendation 13.15 split into?
Recommendation 13.15 was split into two recommendations, now known as 13.17 and 13.18.
What is the purpose of the S8 summary of revisions?
The S8 summary of revisions provides an overview of the changes made in the Diabetes Care Volume 46, Supplement 1, January 2023, specifically focusing on the Chronic Kidney Disease section and recommendations related to diabetes management and risk management.
Describe the revisions made in the Standards of Care for diabetes management.
The revisions aim to improve consistency, include different methodologies, and utilize computerized prescriber order entry (CPOE) and machine learning algorithms for glycemic management.
What is the recommended blood pressure target for pregnant individuals with diabetes?
The recommended blood pressure target for pregnant individuals with diabetes is stricter to improve outcomes.
Define the term ‘pediatric diabetes care teams’.
Pediatric diabetes care teams refer to healthcare professionals who provide care for children and young adults with diabetes.
How does breastfeeding reduce the risk of maternal type 2 diabetes?
Breastfeeding is supported to reduce the risk of maternal type 2 diabetes.
Describe the preferred treatment for most non-critically ill hospitalized patients with adequate nutritional intake.
The preferred treatment is an insulin regimen with basal, prandial, and correction components.
What is the purpose of the American Diabetes Association (ADA) Standards of Care in Diabetes?
To provide clinical practice recommendations and tools for evaluating quality of care in diabetes.
Describe the role of the ADA Professional Practice Committee.
The committee is responsible for updating the Standards of Care annually and consists of multidisciplinary experts.
What is the Chronic Care Model in diabetes management?
It emphasizes person-centered team care, integrated long-term treatment approaches, and ongoing collaborative communication.
How should treatment decisions in diabetes care be made?
They should be timely, evidence-based, collaborative with patients, and consider individual preferences, prognoses, comorbidities, and financial considerations.
What are some recommendations for diabetes care systems?
They should facilitate team-based care, utilize patient registries and decision support tools, and involve community participation.
Define diabetes health care maintenance.
It involves assessing and improving processes of care and health outcomes using reliable data metrics.
Describe the purpose of Table 4.1 in the content.
It provides a framework for assessing diabetes health care maintenance using relevant data metrics.
Describe patient-centered care.
Patient-centered care is defined as care that considers individual patient comorbidities and prognoses; is respectful of and responsive to patient preferences, needs, and values; and ensures that patient values guide all clinical decisions.
What are the social determinants of health (SDOH)?
Social determinants of health are factors that are often out of the individual’s control and potentially represent lifelong risk, contributing to health care and psychosocial outcomes.
What is the annual cost of diagnosed diabetes in the U.S. in 2017?
The annual cost of diagnosed diabetes in the U.S. in 2017 was $327 billion, including $237 billion in direct health care costs and $90 billion in reduced productivity.
Define the Chronic Care Model (CCM).
The Chronic Care Model (CCM) is a model of care delivery that aims to improve the quality of care for patients with chronic conditions, such as diabetes. It focuses on proactive, planned, and coordinated care.
How did the use of the Chronic Care Model (CCM) impact patients with type 2 diabetes in a primary care setting?
A 5-year effectiveness study of the CCM in 53,436 people with type 2 diabetes in the primary care setting suggested that the use of this model of care delivery reduced the cumulative incidence of diabetes-related complications and all-cause mortality. Patients who were enrolled in the CCM experienced a reduction in cardiovascular disease risk, microvascular complications, and mortality.
What is telehealth?
Telehealth describes a broader range of digital health services in health care delivery, including synchronous, asynchronous, and remote patient monitoring.
How can telehealth be used in diabetes care?
Telehealth can be used to complement in-person visits and optimize glycemic management in people with unmanaged diabetes.
Describe the role of the care team in diabetes care.
The care team, which centers around the patient, should avoid therapeutic inertia and prioritize timely and appropriate care.
Describe the role of the care team in diabetes care.
The care team, which centers around the patient, should avoid therapeutic inertia and prioritize timely and appropriate care.
What are the cost considerations for medication-taking behaviors in diabetes care?
The cost of diabetes medications and devices is an ongoing barrier to achieving glycemic control.
What is the National Diabetes Education Program?
The National Diabetes Education Program maintains an online resource to help health care professionals design and implement more effective health care delivery systems for those with diabetes.
What is the purpose of the Affordable Care Act and Medicaid expansion?
To increase access to care for individuals with diabetes and protect people with preexisting conditions.
How has health insurance coverage changed for adults with diabetes aged 18-64 years?
Coverage increased from 84.7% in 2009 to 90.1% in 2016.
What are some cost-related barriers to medication use for individuals with diabetes?
Financial stress and food insecurity.
Describe the role of standardized sociodemographic variables in electronic health records.
They facilitate the measurement of health inequities and the impact of interventions to reduce those inequities.
What is the purpose of the National Quality Strategy developed by the Agency for Healthcare Research and Quality?
To improve the health of a population, overall quality and patient experience of care, and per capita cost.
How can community health workers support treatment decisions for individuals with diabetes?
By providing additional self-management support and referring to appropriate local community resources.
How can community health workers support treatment decisions for individuals with diabetes?
By providing additional self-management support and referring to appropriate local community resources.
How can community health workers support treatment decisions for individuals with diabetes?
By providing additional self-management support and referring to appropriate local community resources.
What percentage of adults with diabetes reported financial stress and food insecurity?
One-half reported financial stress and one-fifth reported food insecurity.
Describe the impact of health insurance coverage on meeting quality indicators for diabetes care.
Patients with private or public insurance coverage are more likely to meet quality indicators for diabetes care.
Describe the barriers that migrant farmworkers with diabetes may encounter in receiving care.
Migrant farmworkers may face barriers such as migration disrupting care, cultural and linguistic barriers, lack of transportation and money, lack of access to resources, and food insecurity.
What is the impact of food insecurity on individuals with diabetes?
Food insecurity has been associated with a higher risk of type 2 diabetes, lower engagement in self-care behaviors and medication use, depression, diabetes distress, and worse glycemic management.
Define homelessness/housing insecurity and its association with diabetes.
Homelessness/housing insecurity refers to the lack of secure housing and is associated with a higher prevalence of diabetes, emergency department visits, hospitalizations, and difficulties in managing diabetes due to lack of access to supplies and refrigeration.
How can health care professionals support individuals with diabetes who are homeless?
Health care professionals can provide appropriate referrals to social workers and community resources, assist with assessing the risk for homelessness, and help ensure access to secure housing and proper storage of diabetes supplies and medication.
Describe the role of diabetes care and education specialists.
Diabetes care and education specialists play a crucial role in improving care and promoting health in populations with diabetes.
What is the importance of addressing low health literacy in populations with diabetes?
Addressing low health literacy in populations with diabetes is important for improving diabetes outcomes and incorporating relevant social support networks.
How can combining easily adapted materials with formal diabetes education benefit populations with low literacy?
Combining easily adapted materials with formal diabetes education has been shown to be effective in improving clinical and behavioral outcomes in populations with low literacy.
Define health care community linkages and their significance in diabetes care.
Health care community linkages refer to the connections between healthcare providers and community resources, and they are receiving increasing attention in diabetes care for promoting better outcomes.
Describe the findings of the study by Jaffe et al. regarding blood pressure control in a large-scale hypertension program.
Improved blood pressure control was associated with a large-scale hypertension program, as reported by Jaffe et al.
Define shared decision-making in diabetes care.
Shared decision-making in diabetes care refers to the collaborative process between healthcare providers and patients in making treatment decisions based on the patient’s preferences and values.
What were the effects of care coordination on hospitalization, quality of care, and healthcare expenditures among Medicare beneficiaries, according to Peikes et al.?
Peikes et al. found that care coordination resulted in reduced hospitalization rates, improved quality of care, and lower healthcare expenditures among Medicare beneficiaries.
Describe the purpose of the digital self-management intervention developed by Dack et al. for adults with type 2 diabetes.
Dack et al. developed a digital self-management intervention for adults with type 2 diabetes to combine theory, data, and participatory design in order to improve diabetes management.
What are the three archetypes of top-performing practice sites in diabetes care, as identified by Feifer et al.?
Feifer et al. identified three archetypes of top-performing practice sites in diabetes care, representing different paths to high-quality care.
Describe the active care management supported by home telemonitoring in veterans with type 2 diabetes, as studied by Stone et al.
Stone et al. investigated active care management supported by home telemonitoring in veterans with type 2 diabetes, which involved monitoring and managing the condition remotely to improve patient outcomes.
What is the user utility score for diabetes management developed by Lee et al. using tailored mobile coaching?
Lee et al. developed a novel user utility score for diabetes management using tailored mobile coaching, which aimed to enhance the effectiveness of diabetes management.
Define medication adherence and persistence in the context of research employing electronic databases, as standardized by Reed et al.
Reed et al. standardized the definitions of medication adherence and persistence in research employing electronic databases, referring to the extent to which patients follow prescribed medication regimens over time.
Describe the objectives for 2020 outlined in the Phase I report from the National Institute of Diabetes and Digestive and Kidney Diseases.
Recommendations for the framework and format of diabetes care for populations experiencing homelessness.
Define outpatient diabetes clinical decision support.
Current status and future directions of clinical decision support for diabetes management in outpatient settings.
Describe the instrument developed to assess imminent risk of homelessness among veterans.
An instrument to assess the likelihood of veterans becoming homeless in the near future.
Explain the association between housing insecurity and health outcomes and unhealthy behaviors.
The impact of housing insecurity on health outcomes and the development of unhealthy behaviors.
Describe the role of community health workers in type 2 diabetes mellitus prevention and disease management.
Community health workers play a role in preventing and managing type 2 diabetes through various activities such as education, support, and self-management assistance.
What is the purpose of self-management education programmes led by lay leaders for people with chronic conditions?
The purpose of self-management education programmes led by lay leaders is to provide support and education to individuals with chronic conditions, including diabetes, to help them better manage their health.
Define peer mentoring in the context of diabetes self-management support.
Peer mentoring in diabetes self-management support refers to the practice of individuals with diabetes providing guidance, support, and encouragement to others with the condition, based on their own experiences and knowledge.
How can peer leaders be integrated and utilized in diabetes self-management support?
Peer leaders can be integrated and utilized in diabetes self-management support by providing guidance, education, and support to individuals with diabetes, helping them improve their self-management skills and overall health outcomes.
Describe the role of the ADA Professional Practice Committee in updating the Standards of Care.
The ADA Professional Practice Committee, a multidisciplinary expert committee, is responsible for updating the Standards of Care annually or as needed.
How is Type 1 diabetes classified?
Type 1 diabetes is classified as autoimmune B-cell destruction, usually leading to absolute insulin deficiency, including latent autoimmune diabetes of adulthood.
Define Type 2 diabetes.
Type 2 diabetes is a non-autoimmune progressive loss of adequate B-cell insulin secretion, often accompanied by insulin resistance and metabolic syndrome.
Define Type 2 diabetes.
Type 2 diabetes is a non-autoimmune progressive loss of adequate B-cell insulin secretion, often accompanied by insulin resistance and metabolic syndrome.
What are some specific types of diabetes due to other causes?
Some specific types of diabetes due to other causes include monogenic diabetes syndromes, diseases of the exocrine pancreas, and drug- or chemical-induced diabetes.
Define Type 2 diabetes.
Type 2 diabetes is a non-autoimmune progressive loss of adequate B-cell insulin secretion, often accompanied by insulin resistance and metabolic syndrome.
What are some specific types of diabetes due to other causes?
Some specific types of diabetes due to other causes include monogenic diabetes syndromes, diseases of the exocrine pancreas, and drug- or chemical-induced diabetes.
Define Type 2 diabetes.
Type 2 diabetes is a non-autoimmune progressive loss of adequate B-cell insulin secretion, often accompanied by insulin resistance and metabolic syndrome.
What are some specific types of diabetes due to other causes?
Some specific types of diabetes due to other causes include monogenic diabetes syndromes, diseases of the exocrine pancreas, and drug- or chemical-induced diabetes.
Define Type 2 diabetes.
Type 2 diabetes is a non-autoimmune progressive loss of adequate B-cell insulin secretion, often accompanied by insulin resistance and metabolic syndrome.
What are some specific types of diabetes due to other causes?
Some specific types of diabetes due to other causes include monogenic diabetes syndromes, diseases of the exocrine pancreas, and drug- or chemical-induced diabetes.
Define Type 2 diabetes.
Type 2 diabetes is a non-autoimmune progressive loss of adequate B-cell insulin secretion, often accompanied by insulin resistance and metabolic syndrome.
What are some specific types of diabetes due to other causes?
Some specific types of diabetes due to other causes include monogenic diabetes syndromes, diseases of the exocrine pancreas, and drug- or chemical-induced diabetes.
Define Type 2 diabetes.
Type 2 diabetes is a non-autoimmune progressive loss of adequate B-cell insulin secretion, often accompanied by insulin resistance and metabolic syndrome.
What are some specific types of diabetes due to other causes?
Some specific types of diabetes due to other causes include monogenic diabetes syndromes, diseases of the exocrine pancreas, and drug- or chemical-induced diabetes.
Define Type 2 diabetes.
Type 2 diabetes is a non-autoimmune progressive loss of adequate B-cell insulin secretion, often accompanied by insulin resistance and metabolic syndrome.
What are some specific types of diabetes due to other causes?
Some specific types of diabetes due to other causes include monogenic diabetes syndromes, diseases of the exocrine pancreas, and drug- or chemical-induced diabetes.
Describe gestational diabetes mellitus.
Gestational diabetes mellitus refers to diabetes diagnosed in the second or third trimester of pregnancy that was not clearly overt diabetes before pregnancy.
What is the purpose of the Introduction and Methodology section in the ADA Standards of Care?
To provide a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system and a full list of Professional Practice Committee members.
Do the ADA Standards of Care cover all forms of diabetes?
No, the section on classification reviews the most common forms of diabetes but is not comprehensive.
Describe the classification of diabetes.
Diabetes is currently classified into type 1 and type 2 diabetes based on clinical, pathophysiological, and genetic characteristics.
What are the features most useful in discriminating type 1 diabetes?
Younger age at diagnosis (<35 years), lower BMI (<25 kg/m²), unintentional weight loss, ketoacidosis, and glucose >360 mg/dL (20 mmol/L) at presentation.
Define diabetic ketoacidosis (DKA).
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes characterized by high blood glucose levels, ketone production, and metabolic acidosis.
How is the classification of diabetes expected to change in the future?
Future classification schemes for diabetes are likely to focus on the underlying pathophysiology, including genetics, inflammation, and metabolic stress.
Describe the diagnostic tests for diabetes.
Diabetes may be diagnosed based on plasma glucose levels. Diagnostic tests also consider the presence of autoantibodies, their number, specificity, and titer.
