Of little surprise to the readership of Diabetes Spectrum, diabetes and prediabetes remain major health concerns in the United States, as well as globally. According to 2017 estimates from the Centers for Disease Control and Prevention, >9% of the U.S. population (a staggering 30.3 million individuals) currently lives with diabetes (1). Given the vast number of people with diabetes requiring medical care, diabetes is largely a condition managed in the primary care setting. One of many challenges facing diabetes educators and primary care providers (PCPs) is remaining current on the multitude of medical guidelines and position statements that are published each year, with diabetes constituting merely one of a myriad of chronic conditions managed within the primary care setting.
The Institute of Medicine defines clinical practice guidelines as “. . . statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options” (2). Clinical guidelines serve a variety of purposes but ultimately aim to provide clinicians with actionable recommendations based on the best evidence available at the time of publication.
To address the unique needs of PCPs, the American Diabetes Association (ADA) takes a proactive approach to disseminating key information to providers on the front-lines in a way that is useful and as up-to-date as possible. For example, in a concerted effort to keep the ADA Standards of Medical Care in Diabetes (3) as current as possible, beginning this year, the Standards exist as a “living document” (4), in which annotated updates are made in response to important events such as:
Approval of new treatments (medications or devices) with the potential to impact patient care;
Publication of new findings that support a change to a recommendation and/or evidence level of a recommendation; or
Publication of a consensus document endorsed by ADA that necessitates an update of the Standards to align content of the documents.
Another example of the ADA’s efforts to disseminate timely and pertinent guideline information is the annual publication in the journal Clinical Diabetes of an abridged version of the Standards tailored especially for PCPs (5). The abridged Standards aim to provide clinicians with the most pertinent action items and recommendations from the full Standards of Care document in a concise 24 pages.
In the spirit of the ADA’s efforts to deliver timely and actionable clinical information to providers on the front-lines, we have assembled an impressive group of experts in this Diabetes Spectrum From Research to Practice section to review recently published guidelines and consensus statements and provide you—the educators and clinicians caring for people with diabetes—with the most salient information from these reports in a concise and useful format.
First in our lineup is an article from Pasquale Passarella, Tatiana A. Kiseleva, Farida V. Valeeva, and Aidar R. Gosmanov, reviewing hypertension management in diabetes (p. 218). This timely review summarizes recent hypertension management guidelines and provides a discussion of the origins of the current blood pressure recommendations and key evidence supporting them.
Our second article is an update on the management of diabetic neuropathy prepared by Lynn Ang, Nathan Cowdin, Kara Mizokami-Stout, and Rodica Pop-Busui (p. 224). This review provides key information and recommendations detailed in the recently published ADA position statement on diabetic neuropathy (6).
Our third offering is a review and summary of the American Association of Clinical Endocrinologists/American College of Endocrinology guideline on Management of Dyslipidemia and Prevention of Cardiovascular Disease Clinical Practice Guidelines (7) by Paul S. Jellinger (p. 234). This article provides a concise and useful summary of the salient lipid guidelines published in 2017.
Erika Leung, Supakanya Wongra-kpanich, and Medha N. Munshi also contributed to this informative research section with a comprehensice review of diabetes management in older adults (p. 245), based, in part, on the ADA position statement “Management of Diabetes in Long-term Care and Skilled Nursing Facilities” (8). These authors point out that, because of the heterogeneity of the elderly population, treatment approaches in older adults must be individualized.
Rounding out our series of articles, we have prepared a brief review of recommendations from the 2018 Standards pertaining to the pharmacological management of hyperglycemia in people with type 2 diabetes (p. 254).
We would like to express our sincere thanks to the amazing clinicians and authors who have contributed to this From Research to Practice section. We are also thankful for all of the work that you, the readership of Diabetes Spectrum, do for people with diabetes. We hope that these articles will serve as a useful resource for you in the important work you do on a daily basis.
Duality of Interest
G.E.U. has received research grant support from AstraZeneca, Bayer, Insulcloud, Merck, Novo Nordisk, and Sanofi and is a consultant or advisory board member for Intarcia and Sanofi. No other potential conflicts of interest relevant to this article were reported.
Author Contributions
G.E.U. reviewed and edited, and J.J.N. wrote the article. G.E.U. is the guarantor of this work and, as such, had full access to all of the references cited and takes responsibility for the accuracy of content.
