To best assist local diabetes communities, AYUDA created a volunteer program As a result local diabetes communities from all corners of Latin America began …
Midwest Health Plan: Diabetes Mellitus Guideline
|The following guideline applies to patients with type 1 and type 2 diabetes mellitus and recommends specific |
|interventions for periodic medical assessment, laboratory tests and |
|education to guide effective patient self-management |
|Eligible |Key Components |Recommendation and Level of Evidence |Special Considerations |
|Population | | | |
|Patients 18 -|Periodic |Assessment should include: |At least twice annually |
|75 years of |Assessment |blood pressure [A] adult target of | |
|age with type| |130/80 | |
|1 or type 2 | |assess cardiovascular risks: | |
|diabetes | | modifiable risks - smoking, |
|
|mellitus | |hypertension, | |
| | |hyperlipidemia, sedentary lifestyle, | |
| | |obesity, | |
| | |stress | |
| | | fixed risks - family history, age 40 |At least annually |
| | |years, | |
| | |gender | |
| | |weight | |
| | |diabetic foot exam [B] | |
| | |depression screening, detection and |
|
| | |diagnosis | |
| |Laboratory tests |Tests should include: |Hemoglobin A1C 1 - 4 times annually |
| |and |hemoglobin A1C [D] |based on individual therapeutic goal 1 |
| |other studies |UA; urine microalbumin measurement | |
| | |unnecessary if UA 1 protein [D] | |
| | |lipid profile, preferably fasting target | |
| | |LDL100mg/dl [B] | |
| | |dilated eye exam by ophthalmologist or | |
| | |optometrist [B], or digiscope [B] | |
| | | |Other studies at least annually |
| |Education,
|Guided self-management/education for: | |
| |counseling and |cardiovascular risk reduction |At least annually |
| |risk factor |smoking cessation intervention [B] | |
| |modification |secondhand smoke avoidance [C] | |
| | |nutrition ie fruits, vegetables, | |
| | |monounsaturated fats and fish | |
| | |regular physical activity | |
| | |foot care | |
| | |glycemic control | |
| | |pre-conception counseling | |
| |Medical |Care should focus
on smoking, hypertension |At each visit until therapeutic goals |
| |recommendations |and lipids: |are achieved |
| | |treatment of hypertension using up to 3-4 | |
| | |anti-hypertensive medications to achieve | |
| | |adult target of 130/80 | |
| | |prescription of ACE inhibitor or | |
| | |Angiotensin Receptor Blocker ARB in | |
| | |patients with hypertension or albuminuria | |
| | |[A] 2 | |
| | |Statins should be used for primary | |
| | |prevention against macrovascular
| |
| | |complications in patients with type 2 | |
| | |diabetes who have any additional | |
| | |cardiovascular risk factors [A] | |
| | |management of cardiovascular risk factors | |
| | |assurance of appropriate immunization | |
| | |status Td, influenza, pneumococcal | |
| | |vaccine [C] | |
| | |Low dose aspirin therapy 75 - 162 mg | |
| | |daily for primary prevention in those at | |
| | |increased cardiovascular risk with type 1 |
|
| | |[C] and type 2 [A] diabetes, unless | |
| | |contraindicated 3 | |
| | | | |
1 Develop or adjust the management plan to achieve normal or near-normal
glycemia with an A1C goal of 7 Less stringent treatment goals may be
appropriate for patients with a history of hypoglycemia, patients with
limited life
expectancies, very young children or older adults and individuals with
comorbid conditions
2Consider referral of patients with serum creatinine value 20 mg/dl
adult value or persistent albuminuria to nephrologist for evaluation
3 Aspirin therapy is not recommended for patients under the age of 21 years
because of the increased risk of Reyes syndrome
Levels of Evidence for the most significant recommendations: A randomized
controlled trials; B controlled trials, no randomization; C
observational studies; D opinion of expert pane
This guideline lists core management steps It is based on
several sources,
including the 2004 American Diabetes Association Clinical Practice
Recommendations wwwdiabetesorg Individual patient considerations and
advances in medical science may supercede or modify these recommendations
Major Depression, Panic Disorder and Generalized Anxiety in Adults in
Primary Care Institute for Clinical Symptoms Improvement, 2001
wwwicsiorg
Approved QIC 12/4/04 Modified 10/04 from the MQIC Guidelines approved
7/04
