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Practice Guideline
. 2022 Oct;28(10):923-1049.
doi: 10.1016/j.eprac.2022.08.002. Epub 2022 Aug 11.

American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update

Lawrence Blonde  1 , Guillermo E Umpierrez  2 , S Sethu Reddy  3 , Janet B McGill  4 , Sarah L Berga  5 , Michael Bush  6 , Suchitra Chandrasekaran  2 , Ralph A DeFronzo  7 , Daniel Einhorn  8 , Rodolfo J Galindo  2 , Thomas W Gardner  9 , Rajesh Garg  10 , W Timothy Garvey  11 , Irl B Hirsch  12 , Daniel L Hurley  13 , Kenneth Izuora  14 , Mikhail Kosiborod  15 , Darin Olson  16 , Shailendra B Patel  17 , Rodica Pop-Busui  9 , Archana R Sadhu  18 , Susan L Samson  19 , Carla Stec  20 , William V Tamborlane Jr  21 , Katherine R Tuttle  22 , Christine Twining  23 , Adrian Vella  13 , Priyathama Vellanki  2 , Sandra L Weber  24
Affiliations
Practice Guideline

American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update

Lawrence Blonde et al. Endocr Pract. 2022 Oct.

Erratum in

Abstract

Objective: The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers.

Methods: The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development.

Results: This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes.

Conclusions: This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.

Keywords: antihyperglycemic medications; atherosclerotic cardiovascular disease; cardiovascular diseases; diabetes; diabetes mellitus; diabetes mellitus, type 1; diabetes mellitus, type 2; diabetic nephropathies; diabetic neuropathies; diabetic retinopathy; dyslipidemias; gestational; guideline; hospitalization; hypertension; hypoglycemia; infertility; interdisciplinary communication; metabolic syndrome; obesity; occupations; prediabetic state; pregnancy; secondary diabetes; sleep apnea syndromes; telemedicine; vaccination.

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Conflict of interest statement

Disclosures and Conflicts of Interest Policy

The Task Force was empaneled in accordance with AACE’s Conflict of Interest (COI) Policy and approved by the AACE COI Subcommittee. All members of the expert Task Force completed AACE’s disclosure form regarding any multiplicities of interests related to commercial and direct financial relationships within the preceding 12 months with companies that develop products connected with endocrine disorders. Categories for disclosure include employment, stock or other ownership, direct financial relationships (eg, speaker or consultant), research funding, authorship or panel involvement on a guideline related to an overlapping topic, or other situations related to a perceived COI. The AACE COI Subcommittee reviewed these disclosures against an AACE-approved list of affected companies for this guideline and reached consensus regarding members who could serve on the Task Force in the nonconflicted majority, those who could serve in the conflicted minority with management strategy, and those who were disqualified from serving on the Task Force. The AACE CPG Oversight Committee reviewed and approved the AACE COI Subcommittee’s decisions regarding manageable COI and empanelment. Members of this Task Force were reminded to update potential disclosures if new potential conflicts arose during their appointments and to verifycurrency of disclosures. AACE made every effort to minimize the potential for conflicts of interest that could influence the recommendations of this CPG.

Figures

Figure 1.
Figure 1.
Decision Tree for Treating Hypercholesterolemia in Persons with Diabetes Mellitus. Copyright © 2022 AACE. May not be reproduced in any form without express written permission from Elsevier on behalf of AACE. Visit https://doi.org/10.1016/j.eprac.2022.08.002 to request copyright permission.
Figure 2.
Figure 2.
Decision Tree for Hypertriglyceridemia in Persons with Diabetes Mellitus. Copyright © 2022 AACE. May not be reproduced in any form without express written permission from Elsevier on behalf of AACE. Visit https://doi.org/10.1016/j.eprac.2022.08.002 to request copyright permission.
Figure 3.
Figure 3.
Guide to Frequency of Monitoring (Number of Times per Year) by Glomerular Filtration Rate and Albuminuria Category Reprinted from Kidney International Supplements, volume 3/issue 1, Kidney Disease: Improving Global Outcomes CKD Work Group, KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease, pp 1– 150, January 2013, with permission from Elsevier. CKD = chronic kidney disease; GFR = glomerular filtration rate GFR and albuminuria grid illustrating the risk of CKD progression, kidney failure, cardiovascular events, cardiovascular and all - cause mortality by color intensity. The number in each box suggests the frequency of monitoring (number of times per year). Green indicates stable disease with annual follow-up measurements if CKD is present. Yellow indicates caution and calls for ≥1 measurement per year. Orange requires 2 measurements per year. Red calls for 3 measurements per year. Deep red may require close monitoring at a frequency of 4 times or more per year (at least every 1 to 3 months). These general parameters are based on expert opinion and must take into account underlying comorbid conditions and disease state, as well as the likelihood of a change in management for any individual.
Figure 4.
Figure 4.
Algorithm for Treatment of Diabetic Peripheral Neuropathy
Figure 5.
Figure 5.
Antihyperglycemic Therapy for Persons with Type 2 Diabetes and Atherosclerotic Cardiovascular Disease (ASCVD), Very High Risk for ASCVD, Heart Failure, Cerebral Vascular Disease, or Chronic Kidney Disease. Copyright © 2022 AACE. May not be reproduced in any form without express written permission from Elsevier on behalf of AACE. Visit https://doi.org/10.1016/j.eprac.2022.08.002 to request copyright permission.
Figure 6.
Figure 6.
Matching Glucose Monitoring Option to Complexity of Antihyperglycemic Regimens. Copyright © 2022 AACE. May not be reproduced in any form without express written permission from Elsevier on behalf of AACE. Visit https://doi.org/10.1016/j.eprac.2022.08.002 to request copyright permission.
See this image and copyright information in PMC

References

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