The American Diabetes Association’s Clinical Practice Recommendations 2013, include major position statement along with additional position statements on a range of diabetes-management-related topics.

The new ADA guidelines raise the target for systolic blood pressure from <130 mm Hg to <140 mm Hg based on evidence that there is not a great deal of additional value in aiming for the lower target, but there is an increase in risk in pushing systolic pressure lower than 140 mm Hg.

The previous target of <130 mm Hg had not been derived from randomized, controlled trials, but from observational studies that seemed to suggest lower is better for blood pressure in those with diabetes. However, the new ADA recommendations do say that a target <130 mm Hg might be appropriate for certain individuals, such as younger patients, as long as it can be achieved "without undue treatment burden." However, raising the systolic threshold should not be interpreted to mean that blood-pressure control is not important.

For patients with type 1 or type 2 diabetes who take multiple daily doses of insulin or are on pump therapy, the previous recommendation had been that these patients perform blood glucose self-monitoring "three or more times daily." Some payers had interpreted that to mean that three tests a day was sufficient for all patients, Dr. Richard Grant (Kaiser Permanente Division of Research, Oakland, CA), incoming chair of the ADA Professional Practice Committee, noted.

The 2013 ADA advice for patients on intensive insulin therapy is for testing at least before meals, occasionally after eating, at bedtime, before exercise or critical tasks such as driving, when low blood glucose is suspected, and after treating low blood glucose to ensure normoglycemia has been reached.

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