Standards of medical care in diabetes--2008

The classification of diabetes includes four clinical classes: * Type 1 diabetes results from (3-cell destruction, usually leading to absolute insulin deficiency) * Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance) * Other specific types of diabetes due to other causes, e.g., genetic defects in β-cell function, genetic defects in insulin action, diseases of the exocrine pancreas (such as cystic fibrosis), and drugor chemical-induced (such as in the treatment of AIDS or after organ transplantation) * Gestational diabetes mellitus (GDM) (diabetes diagnosed during pregnancy) Some patients cannot be clearly classified as type 1 or type 2 diabetes. Guidelines should begin with a summary of their major recommendations instructing health care professionals what to do and how to do it. * Use of checklists that mirror guidelines have been successful at improving adherence to standards of care. * Systems changes, such as provision of automated reminders to health care professionals and patients, reporting of process and outcome data to providers, and especially identification of patients at risk because of failure to achieve target values or a lack of reported values. * Quality improvement programs combining continuous quality improvement or other cycles of analysis and intervention with provider performance data. * Practice changes, such as clustering of dedicated diabetes visits into specific times within a primary care practice schedule and/or visits with multiple health care professionals on a single day and group visits. * Tracking systems with either an electronic medical record or patient registry have been helpful at increasing adherence to standards of care by prospectively identifying those requiring assessments and/or treatment modifications.