Diabetes Management Guidelines

Initial Assessment and Diagnosis

The American Diabetes Association recommends checking for ketosis/ketoacidosis, random blood glucose levels, and HbA1c to determine diabetes type and severity in patients with symptoms or at risk 1
Testing for pancreatic autoantibodies can help differentiate between type 1 and type 2 diabetes in patients with newly diagnosed diabetes 1
For patients with HbA1c ≥8.5% or random glucose ≥250 mg/dL with symptoms, or presence of ketosis, the American Diabetes Association recommends initiating insulin therapy immediately 1

The American Diabetes Association recommends that all patients with diabetes receive comprehensive diabetes self-management education focusing on healthy eating patterns and physical activity as the cornerstone of treatment 2
Performing at least 150 minutes per week of moderate-intensity aerobic activity, spread over at least 3 days with no more than 2 consecutive days without exercise, is recommended for patients with diabetes 3, 4
Adding resistance training at least twice per week can help improve insulin sensitivity and glucose metabolism in patients with diabetes 3, 4
Reducing sedentary time throughout the day is recommended for patients with diabetes to improve glucose metabolism and overall health 2

The American Diabetes Association recommends providing individualized medical nutrition therapy (MNT) by a registered dietitian familiar with diabetes MNT components for patients with diabetes 3, 4
Focusing on nutrient-dense, high-quality foods while decreasing calorie-dense, nutrient-poor foods can help patients with diabetes achieve optimal glucose control 2
Targeting 5% weight loss for all overweight or obese individuals with diabetes can help improve insulin sensitivity and glucose metabolism 3, 4
Choosing from low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets can be effective for weight loss up to 2 years in patients with diabetes 3, 4

The American Diabetes Association recommends initiating metformin at or soon after diagnosis if not contraindicated, starting at 500 mg daily, increasing by 500 mg every 1-2 weeks up to 2,000 mg daily in divided doses for patients with type 2 diabetes 1, 2
When metformin monotherapy at maximum tolerated dose fails to achieve or maintain HbA1c target over 3 months, adding a second agent such as SGLT-2 inhibitors, GLP-1 receptor agonists, sulfonylureas, thiazolidinediones, DPP-4 inhibitors, or basal insulin is recommended 1, 2

The American Diabetes Association recommends targeting HbA1c <7% for most adults with diabetes, with more stringent targets (such as <6.5%) for selected individuals 1, 2
Monitoring HbA1c every 3 months until target is reached, then at least twice yearly, is recommended for patients with diabetes 1, 2
Individualizing blood glucose monitoring plans based on pharmacologic treatment can help patients with diabetes achieve optimal glucose control 1

The American Diabetes Association recommends treating conscious individuals with hypoglycemia using 15-20 g of glucose, though any carbohydrate containing glucose may be used 2, 3, 4
Prescribing glucagon for all individuals at significant risk of severe hypoglycemia, and training caregivers or family members in its administration, is recommended 3, 4

The American Diabetes Association recommends including assessment of psychological and social situation as ongoing part of medical management for patients with diabetes 3, 4
Screening for depression, diabetes-related distress, anxiety, eating disorders, and cognitive impairment when self-management is poor is recommended for patients with diabetes 3, 4

The American Diabetes Association recommends considering bariatric surgery for adults with BMI >35 kg/m² and type 2 diabetes, especially if diabetes or associated comorbidities are difficult to control with lifestyle and pharmacologic therapy 3

Establishing an interprofessional diabetes team including a physician, diabetes care and education specialist, registered dietitian nutritionist, and behavioral health specialist or social worker is recommended for patients with diabetes 1