Cited by 507Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes Management and Education

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

Open access
Blonde, Lawrence, Umpierrez, Guillermo E., Reddy, S. Sethu, McGill, Janet B., Berga, Sarah L., Bush, Michael, Chandrasekaran, Suchitra, DeFronzo, Ralph A. +21 more·2022·Endocrine Practice

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.

Integrity signals

Registry

Crossref · 10.1016/j.eprac.2022.08.002

Cites

1860 of 1861 references verified0 citation errors · 1 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

7 of 11 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Method

    A glucose level of at least 200 mg/dL with symptoms of hyperglycemia confirms the diagnosis of DM.

    “A glucose level ≥200 mg/dL in the presence of hyperglycemia symptoms such as polyuria and polydipsia confirm the diagnosis of DM.”
    Quote in the paperNot yet classified1 of 1 sources checked
    • cites [6] source

      The Diagnostic testing passage (page unavailable) discusses fasting glucose, HbA1c, C-peptide, and antibody tests for evaluating MODY. Neither it nor the other retrieved passages gives a ≥200 mg/dL glucose threshold with hyperglycemia symptoms for diagnosing diabetes; searches for that threshold and symptom-based criterion found no supporting passage in our copy. (LLM, conf=0.73)

      Experimental — accuracy not yet measured
  • Method

    Because the concordance among diagnostic tests is imperfect, diagnosis of DM requires two abnormal test results unless hyperglycemic symptoms accompany a glucose level of at least 200 mg/dL.

    “The concordance between FPG, 2-hour PG, and A1C is not perfect; thus, the diagnosis of DM requires 2 different (fasting glucose and A1C) abnormal test results, either from the same sample or 2 abnormal results on samples drawn on different days.”
    Quote in the paperNot yet classified3 of 3 sources checked
    • cites [3] source

      The paper’s introductory passage says diabetes diagnosis requires confirmation of an elevated glucose or HbA1c result and that two different tests above diagnostic thresholds can provide confirmation. It also says repeating the same test on a later sample is preferred, so two different tests are not required. The Discussion says guidelines were unclear about using two tests from one sample; our copy does not address the quoted exception for symptoms with glucose of at least 200 mg/dL or concordance involving 2-hour PG. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [4] source

      The paper’s opening section says that FPG or 2-hour glucose meets the usual diagnostic criteria when abnormal on more than one occasion, and that classic symptoms with a single random plasma glucose of at least 200 mg/dL are diagnostic. It does not say that confirmation requires two different tests (FPG and A1C), or that two abnormal results from the same sample suffice. Its discussion of test variability supports imperfect reproducibility, but not that specific confirmation rule. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [5] source

      The Discussion reports imperfect agreement among HbA1c, fasting plasma glucose, and 2-hour plasma glucose, and says diabetes diagnosis requires repeated measurement rather than a single test. It does not specify that the two abnormal results must be from different tests, describe the same-sample or different-day options, or state an exception for hyperglycemic symptoms with glucose of at least 200 mg/dL. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Background

    Universal screening for gestational diabetes is recommended because selective screening would miss many cases and universal screening is cost-effective.

    “Universal screening is recommended, as selective screening (only in women with risk factors) would miss a significant number of women with GDM and universal screening has been shown to be cost-effective compared with selective screening.”
    Quote in the paperNot yet classified3 of 7 sources checked
    • cites [9]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [50] source

      The Conclusions recommend GDM screening at 24–28 weeks using a 75-g OGTT. The paper does not compare universal screening with risk-factor-based selective screening or report that universal screening is cost-effective; searches for selective screening and cost-effectiveness found no such comparison. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [51] source
    • cites [52] source
    • cites [53] source
    • cites [54] source

      Section 5.2 recommends universal testing because risk-factor-based selective testing has poor sensitivity for detecting GDM. But section 5.4 says there is a lack of good evidence for the cost-effectiveness of universal testing in both high- and low-resource countries; it does not establish that universal screening is cost-effective compared with selective screening. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites [55] source

      The Conclusions discuss childhood glucose outcomes after maternal GDM, not whether universal screening is recommended. Searches of our copy for selective screening, missed cases, and cost-effectiveness found no passage addressing those claims. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Method

    For most persons with type 1 diabetes, real-time or intermittently scanned CGM is recommended to improve A1C and reduce hypoglycemia and DKA risk.

    “Real-time CGM (rtCGM) or isCGM is recommended for all persons with T1D, regardless of insulin delivery system, to improve A1C levels and to reduce the risk for hypoglycemia and DKA.”
    Quote in the paperNot yet classified
  • Method

    DM is diagnosed using any of three established criteria for elevated blood glucose: fasting plasma glucose, 2-hour plasma glucose after a 75-g OGTT, or A1C.

    “DM is diagnosed by using any of 3 established criteria for elevated blood glucose (BG) concentrations (Table 4). FPG ≥126 mg/dL, 2-hour PG ≥ 200 mg/dL during 75-g OGTT, and A1C ≥ 6.5% are equally appropriate for diagnostic screening (Table 4).”
    Quote in the paperNot yet classified

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Continuous access to CGM for daily use is suggested for people living with T2DM at higher risk of hypoglycaemia, similar to current CGM clinical practice guideline recommendations from Diabetes Canada and the American Association of Clinical Endocrinologists.

    “Continuous access to CGM for daily use is suggested for people living with T2DM at higher risk of hypoglycaemia, similar to the current CGM clinical practice guideline recommendations from Diabetes Canada 56 and the American Association of Clinical Endocrinologists. 57”

    From Continuous glucose monitoring in noninsulin‐treated type 2 diabetes: A critical review of reported trials with an updated systematic review and meta‐analysis of randomised controlled trials (2025) · cites this paper as [57]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured
  • Approximately 2-5 times more patients discontinued orforglipron versus placebo due to adverse events, comparable to other GLP-1 receptor agonists where 5%-15% discontinue in clinical trials.

    “Approximately 2–5 times more patients discontinued orforglipron versus placebo due to adverse events, comparable to other GLP‐1 receptor agonists where 5%–15% discontinue in clinical trials [48].”
  • Current guidelines from major diabetes and cardiology organizations recommend regular resistance and aerobic exercise and increasing daily steps to avoid sedentary behavior.

    “Current guideline recommendations by the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), American College of Sports Medicine (ACSM), American Association of Clinical Endocrinology (AACE), and the American Heart Association (AHA) advocate regular resistance and aerobic exercise, as well as physical activity such as increasing daily steps to avoid sed”
  • AACE and ADA recommend avoiding more than 2 to 3 days between exercise routines to maintain improvement in insulin sensitivity.

    “AACE and the ADA recommend avoiding no more than 2 to 3 days between exercise routines to maintain improvement in insulin sensitivity.”

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • CKD recommendation and rationale give different SGLT2i eligibility thresholds

    Major

    Recommendation 6.4 covers people with T2D and CKD whose eGFR is at least 20, but its evidence base sets the general threshold above 25. The lower threshold is described there only for empagliflozin in people with heart failure, leaving those without heart failure between 20 and 25 covered by the recommendation but not the stated general rule.

  • GDM fasting threshold differs at 92 mg/dL

    Minor

    The one-step diagnostic recommendation includes a fasting glucose of exactly 92 mg/dL, while the later diagnostic criteria require a value greater than 92 mg/dL. The two rules classify a patient at that boundary differently.

  • Semaglutide weekly dose changes by a factor of 1,000

    Minor

    The same discussion gives the higher weekly semaglutide dose as 2.4 mg and then describes an equivalent weekly dose as 2.4 g. Those quantities differ by a factor of 1,000.

  • Diabetes confirmation alternates between two results and two different tests

    Minor

    Recommendation 1.1 permits two abnormal results on different days without requiring different tests. Its evidence base instead says confirmation requires two different tests, specifically fasting glucose and A1C, so the rules disagree on whether repeating one test suffices.

4 of 4

Cited works that were retracted

Works this paper cites that were later retracted, from the retraction notices publishers deposit. Major when the notice came out before this paper was published.

  • Cites a retracted work: 10.1016/j.diabres.2021.108972

    Major

    The cited work was retracted on 2021-07-31 (notice 10.1016/j.diabres.2021.108972), before this paper was published (2022-10). Its authors could have known.

    Cited work 10.1016/j.diabres.2021.108972 · retracted 2021-07-31 · notice 10.1016/j.diabres.2021.108972 · this paper published 2022-10

1 of 1

Cites

1 retracted

Flagged first, then by citations

98 of the 1959 references couldn’t be matched to a known paper.

Research works printed but not linked: 9

  1. Gillett, 2009, International Expert Committee Report on the role of the A1C assay in the diagnosis of diabetes: Diabetes care, Clin Biochem Rev, 30, 197
  2. 1991, VIII. Study design, progress and performance, Diabetologia, 34, 877
  3. Nußbaumer, 2016, Ezetimibe-statin combination therapy, Dtsch arztebl int, 113, 445
  4. Whelton, 2018, Hypertens (Dallas. TX, 71, e13
  5. 2012, KDIGO clinical practice guideline for anemia in chronic kidney disease, Kidney Int Suppl, 2, 279
  6. Miller, 2015, Erratum. J Fam Pract, 64, 452
  7. Mechanick, 2019, Endocr Pract, 25, 1346
  8. 2019, Long-term effects of metformin on diabetes prevention: identification of subgroups that benefited most in the Diabetes Prevention Program and Diabetes Prevention Program Outcomes Study, Diabetes Care, 42, 601, 10.2337/dc18-1970 · DOI · Paper page
  9. American Diabetes Association. Medical management of pregnancy complicated by diabetes fourth edition. Jovanovic L, ed. Alexandria, VA: American Diabetes Association, 2009.

Cited by

Sorted by citations

Authors
Blonde, L., Umpierrez, G. E., Reddy, S. S., McGill, J. B., Berga, S. L., Bush, M., Chandrasekaran, S., DeFronzo, R. A., Einhorn, D., Galindo, R. J., Gardner, T. W., Garg, R., Garvey, W. T., Hirsch, I. B., Hurley, D. L., Izuora, K., Kosiborod, M., Olson, D., Patel, S. B., Pop-Busui, R., Sadhu, A. R., Samson, S. L., Stec, C., Tamborlane, W. V., Tuttle, K. R., Twining, C., Vella, A., Vellanki, P., & Weber, S. L.
Affiliations
  • Ochsner Health System (US)
  • Emory University (US)
  • Central Michigan University (US)
  • Washington University in St. Louis (US)
  • University at Buffalo, State University of New York (US)
  • Cedars-Sinai Medical Center (US)
  • The University of Texas at San Antonio (US)
  • Scripps Whittier Diabetes Institute (US)
  • University of Michigan (US)
  • University of California, Los Angeles (US)
  • University of Alabama at Birmingham (US)
  • University of Washington (US)
  • Mayo Clinic (US)
  • University of Nevada, Las Vegas (US)
  • Saint Luke's Hospital (US)
  • Colorado Health Foundation (US)
  • University of Cincinnati Medical Center (US)
  • Houston Methodist (US)
  • Mayo Clinic in Florida (US)
  • American Association of Clinical Endocrinologists (US)
  • Yale University (US)
  • Maine Medical Center (US)
  • Prisma Health (US)
Venue
Endocrine Practice
Publisher
Elsevier BV
Published
2022-10
Volume
28
Issue
10
Pages
923-1049
ISSN
1530-891X (ISSN-L)
OpenAlex
W4291397630
Cited by
507
References
1,959
Citations by year
2026: 95 · 2025: 119 · 2024: 150 · 2023: 134 · 2022: 9
FWCI
76.49
Type
journal article
Language
en
Update notices
erratum (2023-01-01)
Open access
Locations
  • Endocrine Practice (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (K23DK123384, P30DK111024)
  • National Institute of Diabetes and Digestive and Kidney Diseases
  • BP
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
diabetes mellitus, comprehensive diabetes care, glycemic targets, blood glucose monitoring, diabetes complications, obesity, bariatric surgery, hypertension, dyslipidemia, diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, cardiovascular disease, prediabetes, type 2 diabetes, type 1 diabetes, insulin therapy, hypoglycemia, diabetes in pregnancy, diabetes education, infertility, dietary supplements, social determinants of health, virtual care, cancer risk, pediatric diabetes care, depression, sleep medicine, team-based care
MeSH terms
Child, Diabetes Mellitus, Type 2, Endocrinology, Female, Humans, Hypoglycemic Agents, Insulin, Pregnancy, United States, Dyslipidemias

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