A deeper look into the state of type 2 diabetes in Indigenous Peoples, type 1 diabetes in children and adults, the impact of COVID-19, and diabetes foot-related complicationsView the Diabetes Atlas 2022 Reports
The IDF Diabetes Atlas 10th edition reports a continued global increase in diabetes prevalence, confirming diabetes as a significant global challenge to the health and well-being of individuals, families and societies.
Chapter 2: Stages of type 1 diabetes in children and adolescentsJenny J Couper, Michael J Haller, Carla J Greenbaum, Anette-Gabriele Ziegler, Diane K Wherrett, Mikael Knip and Maria E Craig
Chapter 4: The Diagnosis and management of monogenic diabetes in children and adolescentsAndrew T. Hattersley, Siri Atma W Greeley, Michel Polak, Oscar Rubio-Cabezas, Pål R Njølstad, Wojciech Mlynarski, Luis Castano, Annelie Carlsson, Klemens Raile, Dung Vu Chi, Sian Ellard and Maria E Craig
Chapter 5: Management of cystic fibrosis-related diabetes in children and adolescentsAntoinette Moran, Kubendran Pillay, Dorothy Becker, Andrea Gradados, Shihab Hameed and Carlo L. AceriniChapter Highlights
Chapter 8: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetesLinda A. DiMeglio, Carlo L. Acerini, Ethel Codner, Maria E. Craig, Sabine E. Hofer, Kubendran Pillay and David M. MaahsChapter Highlights
Chapter 9: Insulin treatment in children and adolescents with diabetesThomas Danne, Moshe Phillip, Bruce Buckingham, Przemyslawa Jarosz-Chobot, Banshi Saboo, Tatsuhiko Urakami, Tadej Battelino, Ragnar Hanas and Ethel Codner Chapter Highlights
Chapter 10: Nutritional management in children and adolescents with diabetesCarmel E. Smart, Francesca Annan, Laurie A. Higgins, Elisabeth Jelleryd, Mercedes Lopez and Carlo L. Acerini
Chapter 12: Assessment and management of hypoglycemia in children and adolescents with diabetesMary B Abraham, Timothy W. Jones, Diana Naranjo, Beate Karges, Abiola Oduwole, Martin Tauschmann and David M. Maahs
Chapter 14: Exercise in children and adolescents with diabetesPeter Adolfsson, Michael C Riddell, Craig E Taplin, Elizabeth A Davis, Paul A Fournier, Francesca Annan, Andrea E Scaramuzza, Dhruvi Hasnani and Sabine E. Hofer
Chapter 15: Management of children & adolescents with diabetes requiring surgeryCraig Jefferies, Erinn Rhodes, Marianna Rachmiel, Agwu Juliana Chizo, Thomas Kapellen, Mohamed Ahmet Abdulla and Sabine E. Hofer Chapter Highlights
Chapter 16: Psychological care of children and adolescents with type 1 diabetesAlan M. Delamater, Maartje de Wit, Vincent McDarby, Jamil A. Malik, Marisa E. Hilliard, Elisabeth Northam and Carlo L. Acerini
Chapter 19: Other complications and associated conditions in children and adolescents with type 1 diabetesFarid H Mahmud, Nancy S Elbarbary, Elke Fröhlich-Reiterer, Reinhard W Holl, Olga Kordonouri, Mikael Knip, Kimber Simmons and Maria E CraigChapter Highlights
The first WHO Global report on diabetes demonstrates that the number of adults living with diabetes has almost quadrupled since 1980 to 422 million adults. This dramatic rise is largely due to the rise in type 2 diabetes and factors driving it include overweight and obesity.
The new report calls upon governments to ensure that people are able to make healthy choices and that health systems are able to diagnose, treat and care for people with diabetes. It encourages us all as individuals to eat healthily, be physically active, and avoid excessive weight gain.
This is an abridged version of the current Standards of Care containing the evidence-based recommendations most pertinent to primary care. The recommendations, tables, and figures included here retain the same numbering used in the complete Standards of Care. All of the recommendations included here are substantively the same as in the complete Standards of Care. The abridged version does not include references. The complete 2023 Standards of Care, including all supporting references, is available at professional.diabetes.org/standards.
1.2 Align approaches to diabetes management with the Chronic Care Model. This model emphasizes person-centered team care, integrated long-term treatment approaches to diabetes and comorbidities, and ongoing collaborative communication and goal-setting between all team members. A
1.3 Care systems should facilitate in-person and virtual team-based care, including those knowledgeable and experienced in diabetes management as part of the team and utilization of patient registries, decision support tools, and community involvement to meet patient needs. B
Telehealth may increase access to care for people with diabetes. Telehealth should be used complementary to in-person visits to optimize glycemic management in people with unmanaged diabetes. Evidence suggests that telehealth may be effective at reducing A1C in people with type 2 diabetes compared with or in addition to usual care. Interactive strategies that facilitate communication between HCPs and patients appear more effective.
Diabetes can be classified into the following general categories: Type 1 diabetes (due to autoimmune β-cell destruction, usually leading to absolute insulin deficiency including latent autoimmune diabetes of adulthood)
Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes (such as neonatal diabetes and maturity-onset diabetes of the young), diseases of the exocrine pancreas (such as cystic fibrosis and pancreatitis), and drug- or chemical-induced diabetes (such as with glucocorticoid use, in the treatment of HIV/AIDS, or after organ transplantation)
The classification of diabetes type is not always straightforward at presentation, and misdiagnosis may occur. Therefore, constant diligence and sometimes reevaluation is necessary. Children with type 1 diabetes typically present with polyuria and polydipsia, and approximately half present with diabetic ketoacidosis (DKA). Adults with type 1 diabetes can be diagnosed at any age and may not present with classic symptoms. They may have temporary remission from the need for insulin. The diagnosis may become more obvious over time and should be reevaluated if there is concern.
After the onset of puberty or after 10 years of age, whichever occurs earlier. If tests are normal, repeat testing at a minimum of 3-year intervals (or more frequently if BMI is increasing or risk factor profile deteriorating) is recommended. Reports of type 2 diabetes before age 10 years exist, and this can be considered with numerous risk factors.
2.26a In individuals who are planning pregnancy, screen those with risk factors B and consider testing all individuals of childbearing potential for undiagnosed diabetes. E
3.8 Prediabetes is associated with heightened cardiovascular (CV) risk; therefore, screening for and treatment of modifiable risk factors for cardiovascular disease (CVD) are suggested. B
3.9 Statin therapy may increase the risk of type 2 diabetes in people at high risk of developing type 2 diabetes. In such individuals, glucose status should be monitored regularly and diabetes prevention approaches reinforced. It is not recommended that statins be discontinued. B
3.10 In people with a history of stroke and evidence of insulin resistance and prediabetes, pioglitazone may be considered to lower the risk of stroke or myocardial infarction (MI). However, this benefit needs to be balanced with the increased risk of weight gain, edema, and fracture. A Lower doses may mitigate the risk of adverse effects. C
3.11 In adults with overweight/obesity at high risk of type 2 diabetes, care goals should include weight loss or prevention of weight gain, minimizing the progression of hyperglycemia, and attention to CV risk and associated comorbidities. B
4.5 Ongoing management should be guided by the assessment of overall health status, diabetes complications, CV risk, hypoglycemia risk, and shared decision-making to set therapeutic goals. B
The importance of routine vaccinations for people with diabetes has been elevated by the coronavirus disease 2019 (COVID-19) pandemic. Preventing avoidable infections not only directly prevents morbidity, but also reduces hospitalizations, which may additionally reduce the risk of acquiring infections such as COVID-19. Children and adults with diabetes should receive vaccinations according to age-appropriate recommendations.
In people with diabetes, higher blood glucose levels prior to and during COVID-19 admission have been associated with poor outcomes, including mortality. People with diabetes should be prioritized and offered SARS-CoV-2 vaccines.
People with diabetes should be encouraged to undergo recommended age- and sex-appropriate cancer screenings and to reduce their modifiable cancer risk factors (obesity, physical inactivity, and smoking).
4.10 People with type 2 diabetes or prediabetes with cardiometabolic risk factors, who have either elevated liver enzymes (ALT) or fatty liver on imaging or ultrasound, should be evaluated for presence of nonalcoholic steatohepatitis and liver fibrosis. C
Essential to achieving diabetes treatment goals are DSMES, medical nutrition therapy (MNT), routine physical activity, tobacco cessation counseling when needed, health behavior counseling, and psychosocial care. 2b1af7f3a8