Activity 3: The Role of Diabetes Education in Optimizing Glycemic Control and Improving Outcomes in Type 2 Diabetes

All practice recommendations in this presentation are from the American Diabetes Association.

Source: Executive summary: standards of medical care in diabetes—2009. Diabetes Care 2009;32:S6-S61.


Strength of Evidence: The strength of evidence is indicated following each recommendation. See table below for description of evidence levels.

Recommendation #1: Patients should receive DSME according to national standards when diabetes is diagnosed and as needed thereafter. (B)

Recommendation #2: Patients should receive individualized MNT as needed to achieve treatment goals. (B)

Recommendation #3: Saturated fat intake should be <7% of total calories. (A)

Recommendation #4: Intake of trans fat should be minimized. (B)

Recommendation #5: Monitoring carbohydrate remains a key strategy in achieving glycemic control. (A)

Recommendation #6: Weight loss is recommended for overweight or obese individuals who have or are at risk for DM. (A)

Recommendation #7: Physical activity and behavior modification are important components of weight loss and most helpful in maintenance of weight loss. (B)

Recommendation #8: Patients should be advised to perform at least 150 min/week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate). (A)

Recommendation #9: In the absence of contraindications, patients should be encouraged to perform resistance training three times per week. (A)

Recommendation #10: Self-management behavior change is the key outcome of DSME and should be measured and monitored as part of care. (E)

Recommendation #11: SMBG should be carried out three or more times daily for patients using multiple insulin injections or insulin pump therapy. (A)

Recommendation #12: For patients using less frequent insulin injections, noninsulin therapies, or MNT and physical activity alone, SMBG may be useful as a guide to the success of therapy. (E)

Recommendation #13: To achieve postprandial glucose targets, postprandial SMBG may be appropriate. (E)

Recommendation #14: When prescribing SMBG, ensure that patients receive initial instruction in, and routine follow-up evaluation of, SMBG technique and their ability to use data to adjust therapy. (E)

Recommendation #15: Preprandial capillary plasma glucose: 70-130 mg/dL

Recommendation #16: Peak postprandial capillary plasma glucose: <180mg/dL

Definitions of the ADA’s Level of Evidence

Level of evidence Description
A Clear evidence from well-conducted, generalizable, randomized controlled trials that are
adequately powered, including:
• Evidence from a well-conducted multicenter trial
• Evidence from a meta-analysis that incorporated quality ratings in the analysis
Compelling nonexperimental evidence, i.e., the “all or none” rule developed by the
Centre for Evidence-Based Medicine at Oxford
Supportive evidence from well-conducted randomized controlled trials that are
adequately powered, including:
• Evidence from a well-conducted trial at one or more institutions
• Evidence from a meta-analysis that incorporated quality ratings in the analysis
B Supportive evidence from well-conducted cohort studies, including:
• Evidence from a well-conducted prospective cohort study or registry
• Evidence from a well-conducted meta-analysis of cohort studies
Supportive evidence from a well-conducted case-control study
C Supportive evidence from poorly controlled or uncontrolled studies, including:
• Evidence from randomized clinical trials with one or more major or three or more
minor methodological flaws that could invalidate the results
• Evidence from observational studies with high potential for bias (such as case
series with comparison to historical controls)
• Evidence from case series or case reports
Conflicting evidence with the weight of evidence supporting the recommendation
E Expert consensus or clinical experience


Download PDF of EB Recs

This file contains a PDA version of the lecture notes for the material covered in the Learning Link activities on Diabetes.
Download Lecture Notes
Installation Instructions
RediReader for Palm OS
RediReader for Pocket PC

The second file contains a comprehensive searchable PDA reference for Palm OS and Pocket PC/Windows Mobile devices that contains:

  1. American Diabetes Associations Standards of Care
  2. Official recommendations on the medical management of hyperglycemia including initiation of insulin
  3. Updated recommendations for inpatient management of hyperglycemia
  4. Information about insulin preparations and blood glucose monitor

Decision Support Tool

Presentation Slides for Challenging Cases in Effective Management of Type 2 Diabetes

Patient Education

Vision Impaired Resources:

Culturally Sensitive Materials





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