Cited by 362Diabetes Management and EducationDiabetes Management and ResearchDiabetes Treatment and Management

The DOI matches its Crossref record; 435 of the 442 references it cites were found in a registry or an index; 7 of the 514 sources its claims cite were checked for support.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:Standards of Care in Diabetes—2023

Open access

Abstract

The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This ADA Standards of Care section provides clinical practice recommendations for facilitating positive health behaviors and well-being in diabetes, covering DSMES, medical nutrition therapy, physical activity, smoking cessation, behavioral strategies, and psychosocial care. It synthesizes evidence to recommend person-centered care, routine psychosocial screening, and individualized nutrition and activity plans, while noting low DSMES uptake and research gaps.

Key findings

  • DSMES is associated with improved diabetes knowledge and self-care, lower A1C, lower self-reported weight, improved quality of life, reduced all-cause mortality risk, and reduced health care costs; yet only 5–7% of individuals eligible through Medicare or private insurance actually receive it.
  • MNT delivered by an RDN is associated with A1C absolute decreases of 1.0–1.9% for type 1 diabetes and 0.3–2.0% for type 2 diabetes; weight loss goals are 7–10% for preventing progression from prediabetes and at least 5% for overweight/obesity with type 2 diabetes.
  • Physical activity recommendations include 150+ min/week of moderate-to-vigorous aerobic activity for most adults, spread over at least 3 days/week with no more than 2 consecutive days without activity, and 60+ min/day for children/adolescents; structured exercise interventions of at least 8 weeks lower A1C by an average of 0.66% in type 2 diabetes.
  • Diabetes distress prevalence is reported at 18–45%, with 38–48% incidence over 18 months in type 2 diabetes; in DAWN2, 45% reported significant diabetes distress but only 24% reported that their health care teams asked how diabetes affected their lives. Depression affects one in four people with type 1 or type 2 diabetes.

Methods

  • This is the ADA Standards of Care in Diabetes—2023, Section 5, a clinical practice guideline updated annually by the multidisciplinary ADA Professional Practice Committee; detailed methodology and evidence-grading system are referenced to the Introduction and Methodology.
  • The section narratively synthesizes cited literature and expert consensus into recommendations graded A, B, C, or E; no primary data collection, systematic review, or meta-analysis is conducted in this section.

Limitations

  • Stated: there is inadequate research in type 1 diabetes to support one eating pattern over another; there is a paucity of evidence and agreement on nutrition management among children and adolescents with type 1 diabetes; and a significant literature gap remains for young children with type 1 diabetes.
  • Stated: more data are needed to identify optimal long-term meal plans, the optimal degree of carbohydrate restriction, and long-term cardiovascular effects; little outcome data exist on long-term systematic treatment of diabetes distress integrated into routine care.
  • Evident: as a guideline section, the provided text does not report its own search strategy, inclusion criteria, or quality appraisal; many recommendations are expert opinion or grade C/E.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2337/dc23-s005

Cites

435 of 435 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

262 Not checked yet · 19 No basis given · 3 Own interpretation · 2 Partly supported · accuracy not yet measured

Verify all 507 references — free account

Show all 199 claims

  • Probably not a substantial claim. 27
  • It may state two separate claims as one. 65
87 of 87
  • The paper relies on this without support.

    Support from institutional leadership is foundational for the success of diabetes self-management education and support services.

    “Support from institutional leadership is foundational for the success of DSMES services.”
  • The paper relies on this without support.

    There is not a one-size-fits-all eating pattern for individuals with diabetes.

    “There is not a “one-size-fits-all” eating pattern for individuals with diabetes, and meal planning should be individualized.”
  • The paper relies on this without support.

    Because of the progressive nature of type 2 diabetes, behavior modification alone may not be adequate to maintain euglycemia over time.

    “Because of the progressive nature of type 2 diabetes, behavior modification alone may not be adequate to maintain euglycemia over time.”
  • The paper relies on this without support.

    Management and reduction of weight is important for people with type 1 diabetes, type 2 diabetes, or prediabetes with overweight or obesity.

    “Management and reduction of weight is important for people with type 1 diabetes, type 2 diabetes, or prediabetes with overweight or obesity.”
  • The paper relies on this without support.

    Disordered eating, eating disorders, and/or disrupted eating can increase challenges for weight and diabetes management.

    “Disordered eating, eating disorders, and/or disrupted eating can increase challenges for weight and diabetes management.”
  • The paper relies on this without support.

    Diabetes self-management education and support is also covered by most health insurance plans.

    “DSMES is also covered by most health insurance plans.”
  • The paper relies on this without support.

    Diabetes self-management education and support is frequently reimbursed when performed in person.

    “DSMES is frequently reimbursed when performed in person.”
  • The paper relies on this without support.

    Ongoing support has been shown to be instrumental for improving outcomes when it is implemented after the completion of education services.

    “Ongoing support has been shown to be instrumental for improving outcomes when it is implemented after the completion of education services.”
  • The paper relies on this without support.

    Psychosocial factors influence living with diabetes, both type 1 and type 2, and achieving optimal health outcomes and psychological well-being.

    “Complex environmental, social, family, behavioral, and emotional factors, known as psychosocial factors, influence living with diabetes, both type 1 and type 2, and achieving optimal health outcomes and psychological well-being.”
  • The paper relies on this without support.

    Emotional well-being is an important part of diabetes care and self-management.

    “Emotional well-being is an important part of diabetes care and selfmanagement.”
  • The paper relies on this without support.

    Significant changes in life circumstances and social determinants of health considerably affect a person's ability to self-manage their condition.

    “Significant changes in life circumstances and SDOH are known to considerably affect a person's ability to self-manage their condition.”
  • The paper relies on this without support.

    There is little outcome data on long-term systematic treatment of diabetes distress integrated into routine care.

    “As with treatment of other diabetesassociated behavioral and psychosocial factors affecting disease outcomes, there is little outcome data on long-term systematic treatment of diabetes distress integrated into routine care.”
  • The paper relies on this without support.

    Integrating mental and physical health care can improve outcomes.

    “Integrating mental and physical health care can improve outcomes.”
  • The paper relies on this without support.

    Depressive symptoms may be a manifestation of reduced quality of life secondary to disease burden and resultant changes in resource allocation impacting the person and their family.

    “Depressive symptoms may also be a manifestation of reduced quality of life secondary to disease burden (also see DIABETES DISTRESS, above) and resultant changes in resource allocation impacting the person and their family.”
  • The paper relies on this without support.

    Mixed intervention results point to the need for treatment of eating disorders and disordered eating behavior in the context of the disease and its treatment.

    “Mixed intervention results point to the need for treatment of eating disorders and disordered eating behavior in the context of the disease and its treatment.”
  • The paper relies on this without support.

    Serious mental illness is often associated with the inability to evaluate and utilize information to make judgments about treatment options.

    “Serious mental illness is often associated with the inability to evaluate and utilize information to make judgments about treatment options.”
  • The paper relies on this without support.

    Cognitive capacity contributes to the ability to benefit from diabetes education.

    “Cognitive capacity also contributes to ability to benefit from diabetes education”
17 of 17

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?

Citations

Cites

Research works printed but not linked: 2

  1. 2018 Physical Activity Guidelines Advisory Committee, 2018, 2018 Physical Activity Guidelines Advisory Committee Scientific Report
  2. Peters, 2013, American Diabetes Association/JDRF Type 1 Diabetes Sourcebook

Cited by

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Metadata

Authors
ElSayed, N. A., Aleppo, G., Aroda, V. R., Bannuru, R. R., Brown, F. M., Bruemmer, D., Collins, B. S., Hilliard, M. E., Isaacs, D., Johnson, E. L., Kahan, S., Khunti, K., Leon, J., Lyons, S. K., Perry, M. L., Prahalad, P., Pratley, R. E., Seley, J. J., Stanton, R. C., Young-Hyman, D., & Gabbay, R. A.
Venue
Diabetes Care
Published
2022-12-12
Volume
46
Issue
Supplement_1
Pages
S68-S96
ISSN
0149-5992 (ISSN-L)
OpenAlex
W4311263988
Cited by
362
References
442
Citations by year
2026: 35 · 2025: 78 · 2024: 146 · 2023: 97
FWCI
11.42
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
diabetes mellitus, health behavior, well-being, health outcomes, clinical guidelines, quality of care, treatment goals, American Diabetes Association standards of care
MeSH terms
Diabetes Mellitus, Endocrinology, Humans, Reference Standards, Societies, Medical, Health Behavior, Standard of Care

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