Diabetes Care Guidelines

The 15-Minute Diabetes Office Visit:

  • Measure the ABCs of diabetes — Hemoglobin A1c, Blood pressure, and Cholesterol
  • Conduct a foot exam
  • Discuss medication adherence
  • Make a self-management plan with patient

To improve clinical practice for better diabetes outcomes, refer to these guidelines.

Diabetes Clinical Guideline
Download this comprehensive clinical care guideline developed by the New York Diabetes Coalition.

Diabetes Care Flowsheet[pdf]
Download this chart to help you track recommended diabetes
treatment frequencies and measures.

Diabetes Quick Care Guide[pdf]
Download this easy-to-use reference guide to comprehensive diabetes care.

Health History Risk Reduction Tobacco Use Annual/ongoing Document tobacco use status and assist smokers to quit.

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Refer patients to the New York State Smokers’
Quitline: 1-866-697-8487.

Annual/ongoing Assess for depression using evidence-based tool, like the PHQ 9.

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Refer to support groups/counseling.

Sexual Functioning Annual/ongoing Discuss functioning and therapy options with both male and female patients.
Preconception Initial/ongoing Target A1C as close to normal (<7%) as possible and evaluate medications.

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Care Plan
Every visit Assess patients’ understanding of diabetes care and treatment.

Set up a self-care plan and individualized goals.

Follow-up to assess progress.

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Physical Exam Blood Pressure Every visit <130/80.

Use ACE/ARB as primary therapy.

Discuss lifestyle modifications.

Weight and BMI Every visit Normal BMI = 18.5 – 24.9 (Centers for Disease Control).Advise weight reduction to optimize BMI.

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Foot Exam Every visit Standardize foot exam forms, check pulses and implement use of monofilaments.
Laboratory A1C Every 3-6 mos. <7.0%; Higher goals may be appropriate if there is Hx of severe hypoglycemia, limited life expectancy, adv vascular disease or extensive comorbid conditions.
Fasting Lipid Profile Cholesterol Annual LDL <100 mg/dl; HDL >40 mg/dl for men, HDL >50 mg/dl for women.

Triglycerides <150 mg/dl.

Patients with overt cardiovascular disease (CVD), lower LDL to goal of <70 mg/dl.

Urine Microalbumin/
Creatinine Ratio
Annual Detect early kidney disease using a “spot” urine albumim-to-creatinine ratio.

Normal: < 30 ug alb/mg creatinine. Abnormal: >30 ug alb/mg creatinine.

If >/= 30 (2 out of 3 specimens in 3-6 month period) and HTN, use ACE-I or ARB.

Serum Creatinine Annual Estimate glomerular filtration rate (GFR) to stage the level of chronic kidney disease (CKD).

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Medication Aspirin Therapy Ongoing 75-162 mg/day.

Primary prevention, consider for: Men >50 years, women >60 years who have one or more additional risk factors for CVD; consider for those younger with multiple risk factors.

Secondary prevention: All persons with CVD (clopidogrel 75 mg/day may be used in persons with ASA allergy).

ACE Inhibitor/ARB** Ongoing Once lifestyle modifications are deemed inadequate, these agents recommended for treatment of HTN and/or microalbuminuria.

*ARB for patients unable to tolerate ACE

Statins Ongoing For all with overt CVD; for those >40 years with one or more CVD risk factor regardless of baseline lipids; <40 years with LDL >100 despite lifestyle modification or with multiple CVD risk factors.
Immunizations Flu Vaccine Every autumn Click for more
Pneumovax Once Revaccinate pts. >65 if initial vaccine given >5 years ago and/or when pt. <65.

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Referrals Dilated Retinal Exam Annual Refer to eye care professional to detect retinopathy.
Dental Care Every 6 mos. Refer for dental exam.
Diabetes Education Annual or more often
as needed
Refer to Certified Diabetes Educator (CDE) to review medications, meal planning, and self-care plan.

Find CDEs: www.diabeteseducator.org/find


Adapted from: American Diabetes Association Standard of Care 2011 and the New York State Diabetes Coalition


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