Funded out Association’s general revenues and does not use industry support. Funded out Association’s general revenues and does not use industry support

Patients with prediabetes should be referred to an intensive diet and physical activity behavioral counseling program adhering to the tenets of the DPP targeting a loss of 7% of body weight, and should increase their moderate physical activity to at least 150 min/week. A

Based on cost-effectiveness of diabetes prevention, such programs should be covered by third-party payers. B

• Based on cost-effectiveness of diabetes prevention, such programs should be covered by third-party payers. B

• Metformin therapy for prevention of type 2 diabetes should be considered in those with prediabetes, especially for those with BMI >35 kg/m2, aged < 60 years, women with prior gestational diabetes (GDM), those with rising A1C despite lifestyle intervention. A

Long-term use of metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy. B

• Long-term use of metformin may be associated with biochemical vitamin B12 deficiency, and periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy. B

Monitor at least annually for the development of diabetes in those with prediabetes. E

• Monitor at least annually for the development of diabetes in those with prediabetes. E

• Screening for and treatment of modifiable risk factors for CVD is suggested. B

DSME and DSMS programs are appropriate for people with prediabetes to receive education and support to develop and maintain behaviors that can prevent or delay the onset of diabetes. B

• DSME and DSMS programs are appropriate for people with prediabetes to receive education and support to develop and maintain behaviors that can prevent or delay the onset of diabetes. B

• Technology assisted tools can be useful elements of effective lifestyle modification to prevent diabetes. B

Two primary techniques available for health providers and patients to assess effectiveness of management plan on glycemic control

• Two primary techniques available for health providers and patients to assess effectiveness of management plan on glycemic control

• Patient self-monitoring of blood glucose (SMBG)
• A1C

• CGM or interstitial glucose may have an important role assessing the effectiveness and safety of treatment in selected patients.

When prescribed as part of a broader educational context, SMBG results may be helpful to guide treatment decisions and/or patient self-management for patients using less frequent insulin injections B or noninsulin therapies. E

• When prescribed as part of a broader educational context, SMBG results may be helpful to guide treatment decisions and/or patient self-management for patients using less frequent insulin injections B or noninsulin therapies. E

• When prescribing SMBG, ensure that patients receive ongoing instruction and regular evaluation of SMBG technique and SMBG results, and their ability to use SMBG data to adjust therapy. E

Most patients on multiple-dose insulin (MDI) or insulin pump therapy should do SMBG B

• Most patients on multiple-dose insulin (MDI) or insulin pump therapy should do SMBG B

• Prior to meals and snacks
• At bedtime
• Prior to exercise
• When they suspect low blood glucose
• After treating low blood glucose until they are normoglycemic
• Prior to critical tasks such as driving
• Occasionally postprandially

When used properly, CGM in conjunction with intensive insulin regimens is a useful tool to lower A1C in selected adults (aged ≥ 25 years) with type 1 diabetes. A

• When used properly, CGM in conjunction with intensive insulin regimens is a useful tool to lower A1C in selected adults (aged ≥ 25 years) with type 1 diabetes. A

• Although the evidence for A1C lowering is less strong in children, teens, and younger adults, CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device. B

• CGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes. C

Given variable adherence to CGM, assess individual readiness for continuing use of CGM prior to prescribing. E

• Given variable adherence to CGM, assess individual readiness for continuing use of CGM prior to prescribing. E

• When prescribing CGM, robust diabetes education, training, and support are required for optimal CGM implementation and ongoing use. E

• People who have been successfully using CGM should have continued access after they turn 65 years of age. E

Perform the A1C test at least 2x annually in patients that meet treatment goals (and have stable glycemic control). E

• Perform the A1C test at least 2x annually in patients that meet treatment goals (and have stable glycemic control). E

• Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. E

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