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
[pdf]
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.

DIABETES QUICK CARE GUIDE
ACTIVITY FREQUENCY GOAL / RECOMMENDATION
Health History Risk Reduction Tobacco Use Annual/ongoing Document tobacco use status and assist smokers to quit.

Click here for more

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

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

Click for more

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.

Click for more

Self-management
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.

Click for more

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.

Click for more

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).

Click here for more

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.

Click for more

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

 

sitemap | design: Better World Advertising (www.socialmarketing.com)