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## Complete Summary

#### GUIDELINE TITLE

American Association of Clinical Endocrinologists medical guidelines for
clinical practice for the management of diabetes mellitus. Diabetes
management in the hospital setting.

#### BIBLIOGRAPHIC SOURCE(S)

AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. AACE
diabetes mellitus guidelines. Diabetes management in the hospital
setting. Endocr Pract 2007 May-Jun;13(Suppl 1):59-63. \[67 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previously published version: American
Association of Clinical Endocrinologists, American College of
Endocrinology. Medical guidelines for the management of diabetes
mellitus: the AACE system of intensive diabetes self-management\--2002
update. Endocr Pract 2002 Jan-Feb;8(Suppl 1):40-82.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Diabetes mellitus, including:

-   Type 1 diabetes

-   Type 2 diabetes

-   Gestational diabetes

#### GUIDELINE CATEGORY

Diagnosis\
Management\
Risk Assessment\
Screening\
Treatment

#### CLINICAL SPECIALTY

Cardiology\
Endocrinology\
Family Practice\
Internal Medicine\
Nursing\
Nutrition\
Obstetrics and Gynecology\
Preventive Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Dietitians\
Nurses\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

To provide clinicians with clear and accessible guidelines to care for
patients with diabetes mellitus

#### TARGET POPULATION

Children, adolescents, and adults with or at risk of developing diabetes
mellitus

#### INTERVENTIONS AND PRACTICES CONSIDERED

1.  Glycemic management plan prior to hospital admission

2.  Data collection and record keeping

    -   Blood glucose concentration

    -   HbA~1c~ level

    -   Point-of-care glucose monitoring

    -   Record diabetes mellitus on medical chart (if diagnosis known)

3.  Meal plan

4.  Target blood glucose levels: preprandial, postprandial, critically
    ill

5.  Insulin management plan

    -   Intravenous insulin infusion

    -   Subcutaneous insulin (scheduled insulin dosing, as needed
        dosing)

6.  Hypoglycemia prevention

    -   Modification of insulin therapy

    -   Intravenous concentrated dextrose

7.  Comanagement of patient with diabetes care professionals

8.  Hospital discharge planning

    -   Inpatient patient education

    -   Intensification of preadmission management plan

    -   Information on when patient should call the clinician

    -   Plan postdischarge follow-up visits

#### MAJOR OUTCOMES CONSIDERED

-   Blood glucose levels

-   Morbidity and mortality

-   Length of hospitalization

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases\
Searches of Unpublished Data

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

References were obtained by performing a computerized search of the
literature using PubMed and other search engines; scanning incoming
journals in the medical library; and reviewing references in
publications relevant to diabetes including review articles, leading
textbooks, and syllabi from national and international meetings.

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

**Levels of Substantiation in Evidence-Based Medicine**^a^

  -------------------------------------------------------------------------------
  Level-of-Evidence   Study Design or      Comments
  Category^b^         Information Type     
  ------------------- -------------------- --------------------------------------
  1                   Randomized           Well-conducted, well-controlled trials
                      controlled trials\   at 1 or more medical centers\
                      \                    \
                      Multicenter trials\  Data derived from a substantial number
                      \                    of trials with adequate power;
                      Large meta-analyses  substantial number of subjects and
                      with quality ratings outcome data\
                                           \
                                           Consistent pattern of findings in the
                                           population for which the
                                           recommendation is made --
                                           generalizable results\
                                           \
                                           Compelling nonexperimental, clinically
                                           obvious evidence (e.g., use of insulin
                                           in diabetic ketoacidosis); \"all or
                                           none\" evidence

  2                   Randomized           Limited number of trials, small number
                      controlled trials\   of subjects\
                      \                    \
                      Prospective cohort   Well-conducted studies\
                      studies\             \
                      \                    Inconsistent findings or results not
                      Meta-analyses of     representative for the target
                      cohort studies\      population
                      \                    
                      Case-control studies 

  3                   Methodologically     Trials with 1 or more major or 3 or
                      flawed randomized    more minor methodologic flaws\
                      controlled trials\   \
                      \                    Uncontrolled or poorly controlled
                      Nonrandomized        trials\
                      controlled trials\   \
                      \                    Retrospective or observational data\
                      Observational        \
                      studies\             Conflicting data with weight of
                      \                    evidence unable to support a final
                      Case series or case  recommendation
                      reports              

  4                   Expert consensus\    Inadequate data for inclusion in
                      \                    level-of-evidence categories 1, 2, or
                      Expert opinion based 3; data necessitates an expert
                      on experience\       panel\'s synthesis of the literature
                      \                    and a consensus
                      Theory-driven        
                      conclusions\         
                      \                    
                      Unproven claims\     
                      \                    
                      Experience-based     
                      information          
  -------------------------------------------------------------------------------

^a^Adapted from the American Association of Clinical Endocrinologists
Protocol for the Standardized Production of Clinical Practice
Guidelines.

^b^Level-of-evidence categories 1 through 3 indicate scientific
substantiation or proof; level-of-evidence category 4 indicates unproven
claims.

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

The American Association of Clinical Endocrinologists (AACE) Task force
members reviewed selected reports and studies and rated the clinical
evidence from these sources.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

When possible, clinical recommendations put forth in the clinical
practice guideline have been assigned a letter grade (A-D) based on the
level of scientific substantiation (see \"Rating Scheme for the Strength
of the Recommendations\"). However, when task force members determined
that clinical judgment regarding a recommendation outweighed study
findings or a recommendation lacked supporting studies, they assigned
the final grade based on their extensive clinical experience and
expertise in diabetes management. An A grade is the strongest
recommendation, and a D grade is the weakest recommendation. These
recommendations include subjective components such as: (a) judgment
regarding whether results from a particular study are conclusive; (b)
the relative weighing of positive and negative conclusive study results;
(c) assignment of evidence rating when certain study methodologies are
controversial; (d) the impact of risk-benefit analysis; (e) the impact
of cost-effectiveness; (f) assessment of geographical differences in
practice standards and availability of certain technologies; (g)
assessment of ethnic, racial, and genetic differences in
pathophysiology; (h) incorporation of patient preferences; and (i)
incorporation of physician preferences.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

**Recommendation Grades in Evidence-Based Medicine**^a^

  -----------------------------------------------------------------------------
  **Grade**   **Description**
  ----------- -----------------------------------------------------------------
  A           Homogeneous evidence from multiple well-designed randomized
              controlled trials with sufficient statistical power\
              \
              Homogeneous evidence from multiple well-designed cohort
              controlled trials with sufficient statistical power\
              \
              [\>]{.underline}1 conclusive level of evidence category 1
              publications demonstrating benefit \>\> outweighs risk

  B           Evidence from at least one large well-designed clinical trial,
              cohort or case-controlled analytic study, or meta-analysis\
              \
              No conclusive level of evidence category 1 publication;
              [\>]{.underline}1 conclusive level of evidence category 2
              publications demonstrating benefit \>\> risk

  C           Evidence based on clinical experience, descriptive studies, or
              expert consensus opinion\
              \
              No conclusive level 1 or 2 publication; [\>]{.underline}1
              conclusive level of evidence category 3 publications
              demonstrating benefit \>\> risk\
              \
              No conclusive risk at all and no conclusive benefit demonstrated
              by evidence

  D           Not rated\
              \
              No conclusive level of evidence category 1, 2, or 3 publication
              demonstrating benefit \>\> risk\
              \
              Conclusive level of evidence category 1, 2, or 3 publication
              demonstrating risk \>\> benefit
  -----------------------------------------------------------------------------

^a^Adapted from the American Association of Clinical Endocrinologists
Protocol for the Standardized Production of Clinical Practice
Guidelines.

#### COST ANALYSIS

Published cost analyses were reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

A separate panel composed of American Association of Clinical
Endocrinologists (AACE) members with expertise in diabetes reviewed the
compiled report. Final recommendations included in this clinical
practice guideline represent a consensus among the task force members
and have been approved by reviewers, the AACE Publications and Executive
Committees, and the AACE Board of Directors.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

The levels of evidence (1--4) and the recommendation grades (A--D) are
defined at the end of the \"Major Recommendations\" field.

**Diabetes Management in the Hospital Setting**

**Hospital Preadmission Planning**

-   For elective hospital admissions, develop a glycemic management plan
    with the patient before admission and share the plan with colleagues
    who will be involved in the patient\'s care (***grade C***)

**Data Collection and Record Keeping**

-   Measure the blood glucose concentration at hospital admission
    (***grade A***)

-   Record \"diabetes mellitus\" on the medical chart, if the diagnosis
    of diabetes mellitus is known (***grade C***)

-   Measure the HbA~1c~ level at hospital admission if hyperglycemia is
    present, if a history of diabetes mellitus exists, or if a HbA~1c~
    value (within the past 3 months) is not available for review
    (***grade B***)

-   Order point-of-care glucose monitoring in a pattern appropriate to
    the patient\'s diagnoses and carbohydrate exposure if hyperglycemia
    is present at hospital admission or if conditions present high risk
    for developing hyperglycemia (***grade A***)

**Meal Plan**

-   For hyperglycemic patients who are eating, either: (a) order a
    consistent carbohydrate diet or (b) for knowledgeable nurses or
    insulin-requiring patients, permit the use of advanced carbohydrate
    counting and nurse-determination or patient self-determination of
    prandial insulin doses (***grade C***)

**Target Blood Glucose Levels**

-   Preprandial, less than 110 mg/dL (***grade C***)

-   Peak postprandial, less than 180 mg/dL (***grade B***)

-   Critically ill patients, between 80 to 110 mg/dL (***grade A***)

**Insulin Management Plan**

-   If appropriate for the patient, use intravenous insulin infusion
    (***grade A***)

-   If hyperglycemia is reproducibly present and intravenous insulin
    infusion is not necessary, order scheduled subcutaneous insulin
    (***grade B***)

-   For subcutaneous management, order amounts of insulin sufficient to
    cover basal and nutritional needs (***grade B***)

-   Plan the patterns of glucose monitoring and delivery of insulin to
    match carbohydrate exposure (***grade B***)

-   Revise the amounts of scheduled insulin daily or more frequently
    based on patient response (***grade B***)

-   For patients receiving scheduled insulin, order an as needed
    correction dose of subcutaneous insulin with dosing that is: (a)
    proportionate to blood glucose elevation and insulin sensitivity of
    the patient and (b) appropriate to time of day; specify the times or
    mealtimes to which the order applies (***grade B***)

**Hypoglycemia Prevention**

-   Modify insulin therapy preventively if a downward trend in blood
    glucose concentrations is observed or there are other conditions
    that predispose to hypoglycemia (***grade A***)

-   For abrupt interruption of carbohydrate exposure within the time
    frame of action of previously administered nutritional insulin,
    treat the patient preemptively with intravenous concentrated
    dextrose before hypoglycemia occurs (***grade B***)

**Comanagement**

-   Work collaboratively with diabetes care professionals from the
    disciplines of nursing, nutrition, pharmacy, quality assurance,
    hospital administration, and others (***grade B***)

**Hospital Discharge Planning**

-   Offer inpatient education to patients regarding medication
    administration (including subcutaneous insulin injections if
    appropriate), glucose monitoring, nutrition, physical activity, and
    other lifestyle factors (***grade B***)

-   At hospital discharge, offer appropriate intensification of the
    patient\'s preadmission management plan (***grade B***)

-   At hospital discharge, provide an explanation of circumstances that
    should prompt the patient to call the clinician for guidance
    (***grade B***)

-   Plan follow-up visits to be conducted after hospital discharge to
    discuss glycemic control and to continue patient education (***grade
    B***)

**Definitions**:

**Levels of Substantiation in Evidence-Based Medicine**^a^

  -------------------------------------------------------------------------------
  Level-of-Evidence   Study Design or      Comments
  Category^b^         Information Type     
  ------------------- -------------------- --------------------------------------
  1                   Randomized           Well-conducted, well-controlled trials
                      controlled trials\   at 1 or more medical centers\
                      \                    \
                      Multicenter trials\  Data derived from a substantial number
                      \                    of trials with adequate power;
                      Large meta-analyses  substantial number of subjects and
                      with quality ratings outcome data\
                                           \
                                           Consistent pattern of findings in the
                                           population for which the
                                           recommendation is made --
                                           generalizable results\
                                           \
                                           Compelling nonexperimental, clinically
                                           obvious evidence (e.g., use of insulin
                                           in diabetic ketoacidosis); \"all or
                                           none\" evidence

  2                   Randomized           Limited number of trials, small number
                      controlled trials\   of subjects\
                      \                    \
                      Prospective cohort   Well-conducted studies\
                      studies\             \
                      \                    Inconsistent findings or results not
                      Meta-analyses of     representative for the target
                      cohort studies\      population
                      \                    
                      Case-control studies 

  3                   Methodologically     Trials with 1 or more major or 3 or
                      flawed randomized    more minor methodologic flaws\
                      controlled trials\   \
                      \                    Uncontrolled or poorly controlled
                      Nonrandomized        trials\
                      controlled trials\   \
                      \                    Retrospective or observational data\
                      Observational        \
                      studies\             Conflicting data with weight of
                      \                    evidence unable to support a final
                      Case series or case  recommendation
                      reports              

  4                   Expert consensus\    Inadequate data for inclusion in
                      \                    level-of-evidence categories 1, 2, or
                      Expert opinion based 3; data necessitates an expert
                      on experience\       panel\'s synthesis of the literature
                      \                    and a consensus
                      Theory-driven        
                      conclusions\         
                      \                    
                      Unproven claims\     
                      \                    
                      Experience-based     
                      information          
  -------------------------------------------------------------------------------

^a^Adapted from the American Association of Clinical Endocrinologists
Protocol for the Standardized Production of Clinical Practice
Guidelines.

^b^Level-of-evidence categories 1 through 3 indicate scientific
substantiation or proof; level-of-evidence category 4 indicates unproven
claims.

**Recommendation Grades in Evidence-Based Medicine**^a^

  -----------------------------------------------------------------------------
  **Grade**   **Description**
  ----------- -----------------------------------------------------------------
  A           Homogeneous evidence from multiple well-designed randomized
              controlled trials with sufficient statistical power\
              \
              Homogeneous evidence from multiple well-designed cohort
              controlled trials with sufficient statistical power\
              \
              [\>]{.underline}1 conclusive level of evidence category 1
              publications demonstrating benefit \>\> outweighs risk

  B           Evidence from at least one large well-designed clinical trial,
              cohort or case-controlled analytic study, or meta-analysis\
              \
              No conclusive level of evidence category 1 publication;
              [\>]{.underline}1 conclusive level of evidence category 2
              publications demonstrating benefit \>\> risk

  C           Evidence based on clinical experience, descriptive studies, or
              expert consensus opinion\
              \
              No conclusive level 1 or 2 publication; [\>]{.underline}1
              conclusive level of evidence category 3 publications
              demonstrating benefit \>\> risk\
              \
              No conclusive risk at all and no conclusive benefit demonstrated
              by evidence

  D           Not rated\
              \
              No conclusive level of evidence category 1, 2, or 3 publication
              demonstrating benefit \>\> risk\
              \
              Conclusive level of evidence category 1, 2, or 3 publication
              demonstrating risk \>\> benefit
  -----------------------------------------------------------------------------

^a^Adapted from the American Association of Clinical Endocrinologists
Protocol for the Standardized Production of Clinical Practice
Guidelines.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each
recommendation (see \"Major Recommendations\").

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Intensive treatment of diabetes mellitus and conditions known to be risk
factors can significantly decrease the development and/or progression of
chronic complications.

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

-   Criticism that purely evidence-based clinical practice guidelines do
    not reflect real life because subjective input is stifled or
    precluded is addressed to some extent by the American Association of
    Clinical Endocrinologists (AACE) methodology for developing the
    guidelines. When the task force members judged that subjective
    factors influenced the grade of a recommendation to an extent that
    outweighed the available best evidence, this logic was explicitly
    described in the detailed discussion that follows each topic
    section\'s executive summary. Thus, the process of developing
    evidence-based recommendations and the incorporation of subjective
    components are transparent to the reader.

-   These methods, nevertheless, have the following shortcomings: (a)
    reliance on some subjective measures, which compromises
    reproducibility; (b) dependence on the best available evidence, even
    if only one study is used to formulate a recommendation grade;
    and (c) dependence on task force primary authors to perform a
    comprehensive literature search. Multiple levels of review by both
    AACE-credentialed and non--AACE-credentialed experts from academia
    and clinical practice backgrounds serve to address these predicted
    shortcomings.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Living with Illness\
Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. AACE
diabetes mellitus guidelines. Diabetes management in the hospital
setting. Endocr Pract 2007 May-Jun;13(Suppl 1):59-63. \[67 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2000 Jan (revised 2007)

#### GUIDELINE DEVELOPER(S)

American Association of Clinical Endocrinologists - Medical Specialty
Society\
American College of Endocrinology - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Association of Clinical Endocrinologists (AACE)

#### GUIDELINE COMMITTEE

American Association of Clinical Endocrinologists (AACE) Diabetes
Mellitus Clinical Practice Guidelines Task Force

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Task Force Members*: Helena W. Rodbard, MD, FACP, MACE (*Chairperson*)
Medical Director, Endocrine and Metabolic Consultants Past President,
American Association of Clinical Endocrinologists Past President,
American College of Endocrinology, Rockville, Maryland; Lawrence Blonde,
MD, FACP, FACE, Director, Ochsner Diabetes Clinical Research Unit;
Section on Endocrinology, Diabetes, and Metabolic Diseases Associate
Residency Program Director, Department of Internal Medicine, New
Orleans, Louisiana; Susan S. Braithwaite, MD, FACP, FACE, Clinical
Professor of Medicine, University of North Carolina, Division of
Endocrinology, Chapel Hill, NC; Elise M. Brett, MD, FACE, Assistant
Clinical Professor of Medicine; Division of Endocrinology, Diabetes, and
Bone Disease; Mount Sinai School of Medicine, New York, New York; Rhoda
H. Cobin, MD, MACE, Clinical Professor of Medicine; Division of
Endocrinology, Diabetes, and Bone Disease; Mount Sinai School of
Medicine, Immediate Past President, American College of Endocrinology,
Past President, American Association of Clinical Endocrinologists, New
York, New York; Yehuda Handelsman, MD, FACP, FACE, Medical Director,
Metabolic Institute of America, Senior Scientific Consultant, Metabolic
Endocrine Education Foundation, Tarzana, California; Richard Hellman,
MD, FACP, FACE, Clinical Professor of Medicine, University of
Missouri-Kansas City School of Medicine, President, American Association
of Clinical Endocrinologists, North Kansas City, Missouri; Paul S.
Jellinger, MD, MACE, Professor of Medicine and Voluntary Faculty,
University of Miami School of Medicine, Past President, American College
of Endocrinology Past President, American Association of Clinical
Endocrinologists, Hollywood, Florida; Lois G. Jovanovic, MD, FACE, CEO &
Chief Scientific Officer, Sansum Diabetes Research Institute, Adjunct
Professor Biomolecular Science and Engineering, University of
California-Santa Barbara, Clinical Professor of Medicine, University of
Southern California, Keck School of Medicine, Santa Barbara, CA; Philip
Levy, MD, FACE, Clinical Professor of Medicine, University of Arizona
College of Medicine, Past President, American College of Endocrinology,
Phoenix, Arizona; Jeffrey I. Mechanick, MD, FACP, FACE, FACN, Associate
Clinical Professor of Medicine and Director of Metabolic Support;
Division of Endocrinology, Diabetes, and Bone Disease; Mount Sinai
School of Medicine, New York, New York; Farhad Zangeneh, MD, FACP, FACE,
Assistant Clinical Professor of Medicine, George Washington University
School of Medicine, Washington, DC, Endocrine, Diabetes and Osteoporosis
Clinic (EDOC), Sterling, Virginia

*Medical Writer*: Christopher G. Parkin, MS

*Reviewers*: Lewis E. Braverman, MD; Samuel Dagogo-Jack, MD, FACE;
Vivian A. Fonseca, MD, FACE; Martin M. Grajower, MD, FACP, FACE;
Virginia A. LiVolsi, MD; Fernando Ovalle, MD, FACE; Herbert I.
Rettinger, MD, FACE; Talla P. Shankar, MD, FACE; Joseph J. Torre, MD,
FACP, FACE; Dace L. Trence, MD, FACE

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Dr. Lawrence Blonde reports that he has received grant/research support
from Amylin Pharmaceuticals, Inc.; AstraZeneca LP; Bristol-Myers Squibb
Company; Eli Lilly and Company; MannKind Corporation; Merck & Co., Inc.;
Novo Nordisk Inc.; Novartis Corporation; Pfizer Inc.; and sanofi-aventis
U.S. He has received speaker and consultant honoraria from Abbott
Laboratories; Amylin Pharmaceuticals, Inc.; Eli Lilly and Company;
GlaxoSmithKline; LifeScan, Inc.; Merck & Co., Inc.; Novartis, Novo
Nordisk Inc.; Pfizer Inc.; and sanofi-aventis U.S. He has received
consultant honoraria from Kos Pharmaceuticals, Inc. and U.S. Surgical.
Dr. Blonde has also disclosed that his spouse is a stock shareholder of
Amylin Pharmaceuticals, Inc. and Pfizer Inc., in an account that is not
part of their community property.

Dr. Susan S. Braithwaite reports that she does not have any financial
relationships with any commercial interests.

Dr. Elise M. Brett reports that her spouse is an employee of Novo
Nordisk Inc.

Dr. Rhoda H. Cobin reports that she has received speaker honoraria from
GlaxoSmithKline; Pfizer Inc.; sanofi-aventis U.S.; and Novartis and
consultant honoraria from Abbott Laboratories.

Dr. Yehuda Handelsman reports that he has received speaker honoraria
from Abbott Laboratories; Amylin Pharmaceuticals, Inc.; AstraZeneca LP;
Bristol-Myers Squibb Company; GlaxoSmithKline; Merck & Co., Inc.;
Novartis; and sanofi-aventis U.S. and consultant honoraria from Abbott
Laboratories; Daiichi Sankyo, Inc.; Novartis; and sanofi-aventis U.S.

Dr. Richard Hellman reports that he has received speaker honoraria from
Daiichi Sankyo, Inc. and Pfizer Inc. and research grants for his role as
an independent contractor from Abbott Laboratories; Pfizer Inc.; and
Medtronic, Inc.

Dr. Paul S. Jellinger reports that he has received speaker honoraria
from Eli Lilly and Company; Merck & Co., Inc.; Novartis; Novo Nordisk
Inc.; and Takeda Pharmaceuticals North America, Inc.

Dr. Lois G. Jovanovic reports that she has received research grants for
her role as investigator from Eli Lilly and Company; DexCom Inc.;
LifeScan, Inc.; Novo Nordisk Inc.; Pfizer Inc.; Roche Pharmaceuticals;
sanofi-aventis U.S.; and Sensys Medical, Inc.

Dr. Philip Levy reports that he has received speaker honoraria from
Abbott Laboratories; Amylin Pharmaceuticals, Inc.; GlaxoSmithKline; Eli
Lilly and Company; Merck & Co., Inc.; Novo Nordisk Inc.; Novartis;
Pfizer Inc.; and sanofi-aventis U.S. and research grants from Amylin
Pharmaceuticals, Inc.; MannKind Corporation; Novo Nordisk Inc.; Pfizer
Inc.; and sanofi-aventis U.S.

Dr. Jeffrey I. Mechanick reports that he does not have any financial
relationships with any commercial interests.

Dr. Helena W. Rodbard reports that she has received consultant honoraria
from Ortho-McNeil, Inc.; Pfizer Inc.; sanofi-aventis U.S.; and Takeda
Pharmaceuticals North America, Inc.; speaker honoraria from Abbott;
GlaxoSmithKline; Merck & Co., Inc.; Novo Nordisk; Pfizer Inc.; and
sanofi-aventis U.S. and research support from Biodel, Inc. and
sanofi-aventis U. S.

Dr. Farhad Zangeneh reports that he has received speaker honoraria from
Eli Lilly and Company; GlaxoSmithKline; Novartis; Novo Nordisk Inc.;
Pfizer Inc.; Roche Pharmaceuticals; sanofi-aventis U.S.; and Takeda
Pharmaceuticals North America, Inc.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previously published version: American
Association of Clinical Endocrinologists, American College of
Endocrinology. Medical guidelines for the management of diabetes
mellitus: the AACE system of intensive diabetes self-management\--2002
update. Endocr Pract 2002 Jan-Feb;8(Suppl 1):40-82.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[American Association of Clinical Endocrinologists (AACE) Web
site](http://www.aace.com/pub/pdf/guidelines/DMGuidelines2007.pdf).

Print copies: Available from the American Association of Clinical
Endocrinologists (AACE), 1000 Riverside Avenue, Suite 205, Jacksonville,
FL 32204.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   American Association of Clinical Endocrinologists protocol for
    standardized production of clinical practice guidelines. Endocrine
    Pract 2004 Jul-Aug; 10(4):353-61.

Electronic copies: Available in Portable Document Format (PDF) from the
[American Association of Clinical Endocrinologists (AACE) Web
site](http://www.aace.com/pub/pdf/guidelines/GLStandards.pdf).

Print copies: Available from the American Association of Clinical
Endocrinologists (AACE), 1000 Riverside Avenue, Suite 205, Jacksonville,
FL 32204.

#### PATIENT RESOURCES

None available

#### NGC STATUS

This NGC summary was completed by ECRI on March 1, 2000. The summary was
verified by the guideline developer as of March 8, 2000. This summary
was updated on April 16, 2002. The information was verified by the
guideline developer on November 11, 2002. This summary was updated by
ECRI Institute on September 27, 2007. The updated information was
verified by the guideline developer on November 12, 2007.

#### COPYRIGHT STATEMENT

All rights reserved. No part of these materials may be reproduced or
retransmitted in any manner without the prior written permission of
American Association of Clinical Endocrinologists (AACE)/American
College of Endocrinology (ACE).

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
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© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008