Diabetes care is an ever-evolving field and the members of the UDPR Panel strive to keep all information and recommendations current according to the most recent and accepted studies and findings. To provide the best available information, the UDPR are based on the American Diabetes Association Standards of Medical Care in Diabetes, current clinical best practices, and international and national studies that are widely accepted by diabetes professionals.
In this edition of the UDPR for Adults, the following updates have been added:
In the 2011 edition of the Standards of Medical Care in Diabetes, hemoglobin A1c (A1C), if measured by a certified lab following Diabetes Control and Complication Trial (DCCT) protocols, was added as a diagnostic tool. For 2012, the reliability of A1C as a screening test is being questioned in elderly patients, those with hemoglobinopathies and/or anemia, and some ethnic groups. Screening using this method may not be as reliable as a 2-hour glucose tolerance test (GTT).
Aspirin therapy is recommended to be individualized based on a patient’s risk of all forms of cardiovascular disease. Updated recommendations are incorporated in the 2012 edition.
The 2012 ADA guideline newly recommends administration of one or more antihypertensive agent(s) at bedtime. See the Cardiovascular section for details.
This edition of the UDPR has been expanded to include sections on Depression and Diabetes and Vaccine Administration.
Since the last edition of this UDPR, additional medications have been developed or changed to generic versions. These medications include:, Linagliptin (Tradjenta), Exenatide ER (Bydureon), Sitagliptin/Metformin XR (Janumet XR), Linagliptin/Metformin (Jentadueto). Pioglitazone (Actos) is now available in generic form and pramlintide is sold only as SymlinPen. Dosage regimens of medications commonly used in the treatment of diabetes are found in Appendix C.
A variety of clinical and patient-education tools have been integrated into this document as embedded Web links and in the appendix. Resources for providers include chronic kidney disease assessment and treatment algorithms, referral forms for diabetic eye exams and tobacco cessation, and a comprehensive foot exam form. Patient handouts cover foot care, self-monitoring of blood glucose, and nutrition.