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
Download this chart to help you track recommended diabetes
treatment frequencies and measures.

Diabetes Quick Care Guide
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