implementation of care and preventive services for people with diabetes. diabetes educator (CDE); curriculum to include the ten …
WISCONSIN ESSENTIAL DIABETES MELLITUS CARE GUIDELINES, 2004 ONE-PAGE
The recommendations in these Essential Diabetes Mellitus Care Guidelines are intended to serve as a guide for clinicians and others involved in the implementation of care and preventive services for people with diabetes They are not intended to replace or preclude clinical judgement Abnormal physical or lab findings should result in follow-up/intervention For particular details and references for each specific area, please refer to the supporting documents and implementation tools in the full-text guideline available via the Internet at http://dhfswisconsingov/health/diabetes/DBMCGuidelnshtm or telephone: 608 261-6871
Concerns
General
Recommendations/
Care/Test
Frequency
Care
Self-Management Education Medical Nutrition Therapy Glycemic Control
Perform diabetes-focused visit Type 1: Every 3 months Type 2: Every 3 6 months consider more often if A1c 70 and/or complications exist Review management plan, assess problems and goals Each focused visit; revise as needed Assess physical activity Each focused visit Assess nutrition/weight/BMI/growth Each focused visit Refer to diabetes educator, preferably a
certified diabetes educator CDE; curriculum to include the ten key areas of the national standards for diabetes selfmanagement education At diagnosis, then every 6 12 months, or more as needed Type 1: At diagnosis; then, if age 18, every 3 6 months; Refer to registered dietician, preferably a CDE; to if age 18, every 6 12 months include areas defined by the American Dietetic Associations Nutrition Practice Guidelines Type 2: At diagnosis; then every 6 12 months or more as needed Check A1c see Algorithm 1 Type 1: Every 3 months Type 2: Every 3 6 months Goal: 70 or 1 above lab norms Review goals, meds, side effects, and frequency of hypoglycemia Each focused visit Assess self-blood glucose monitoring schedule Each focused visit, 2 4 times/day, or as recommended Check lipid profile Children: If 2 years, after diagnosis and once glycemic control is established Repeat annually if abnormal Follow National Adult goals: Total Cholesterol 200 mg/dL Cholesterol Education Program NCEP III guidelines Triglycerides 150 mg/dL Adults: Annually If abnormal, follow NCEP III guidelines HDL 40 mg/dL men HDL 50 mg/dL women Non-HDL Cholesterol 130 mg/dL LDL 100 mg/dL optimal
goal LDL 70 mg/dL for very high risk Blood pressure Each focused visit Adult goal: 130/80 mmHg Pediatric goal: below 90 of ideal for age Assess smoking status Each visit; if smoker, counsel to stop; refer to cessation Start aspirin prophylaxis unless contraindicated Age 40 with diabetes; Age 40, individualize based on risk Check albumin/creatinine ratio using a random urine sample, also called urine microalbumin/creatinine ratio see Algorithm 2 Type 1: Begin with puberty or after 5 years duration, then annually
Cardiovascular Care
Kidney Care
Check serum creatinine Type 2: At diagnosis, then annually Perform routine urinalysis At diagnosis, then annually At diagnosis, then as indicated Type 1: If age 10, within 3 5 years of onset, then annually Eye Care Perform dilated eye exam by an ophthalmologist or optometrist Type 2: At diagnosis, then annually; two exceptions exist see Section 7 Foot Care Inspect feet, with shoes and socks off Each focused visit; stress need for daily self-exam Perform comprehensive lower extremity exam Annually, with monofilament Oral Care Perform oral health screening At diagnosis, then each focused visit Advise dental exam by
general dentist or periodontal specialist At diagnosis, then every 6 months if dentate and every 12 months if edentate Emotional/Sexual Assess emotional health; screen for depression Each focused visit Health Care Assess sexual health concerns Each focused visit Immunizations Provide influenza vaccine Annually, if age 6 months Provide pneumococcal vaccine Once; then per Advisory Committee on Immunization Practices Preconception and Provide preconception counseling/assessment 3 4 months prior to conception Pregnancy Care Assess contraception/discuss family planning At diagnosis and each focused visit Screen for gestational diabetes At 24 28 weeks gestation or sooner if high risk consider referring to provider experienced in care of diabetic women during pregnancy Screening for Pre-diabetes and Diabetes Test all people age 45; if normal and person has no risk factors, Perform fasting plasma glucose test or oral glucose tolerance test see Algorithm 6 retest in 3 years SEE BACK
Screening for Pre-diabetes and Diabetes Test all people 45 years for pre-diabetes and diabetes If screening results are normal and person has no risk factors, re-testing should occur at
3-year intervals Screen at a younger age or more often if the person has one or more risk factors from the following list: 1 Body mass index BMI 25 kg/m2 2 Sedentary lifestyle 3 Prior history of pre-diabetes/glucose intolerance 4 Race/ethnicity eg, African-Americans, Hispanic-Americans, Native Americans, AsianAmericans, and Pacific Islanders 5 Family history of diabetes in one or more first-degree relatives 6 History of hypertension 140/90 mmHg 7 History of vascular disease 8 History of dyslipidemia: HDL 35 mg/dL and/or a triglyceride level 250 mg/dL 9 Markers of insulin resistance: eg, acanthosis nigricans and/or waist circumference 40 inches in men and 35 inches in women 10 History of polycystic ovary syndrome PCOS 11 History of gestational diabetes mellitus GDM in women or delivery of a baby weighing more than nine pounds at birth Table 1: Diagnosis of Pre-diabetes and Diabetes 2004 Criteria Fasting Plasma Glucose Oral Glucose Tolerance Random/Casual Plasma Test FPG Test OGTT Glucose with symptoms
How Performed Blood glucose is measured after at least an 8 hour fast 100 mg/dL 100 125 mg/dL 126 mg/dL 75-gram glucose load drink is ingested after at least an 8 hour fast;
blood glucose is measured at 2 hours 140 mg/dL 140 199 mg/dL 200 mg/dL 200 mg/dL with symptoms Blood glucose is measured at any time regardless of eating
Normal Pre-diabetes IFG Pre-diabetes IGT Diabetes Mellitus
IFG: Impaired fasting glucose IGT: Impaired glucose tolerance Test must be confirmed by repeating on a different day It is not appropriate to have a person eat a meal and then draw a random glucose two hours after
Source:cms.hhs.gov
