To ensure early detection and appropriate treatment of complications manifested by diabetes. a. Blood pressure should be measured at every routine diabetes visit. …
PURPOSE
To ensure early detection and appropriate treatment of complications
manifested by diabetes
PROCEDURE
1 Blood Glucose
a All diabetic will have 2 HgA1c/year with minimum of 3 months
apart
2 Blood Pressure Control
a Blood pressure should be measured at every routine diabetes
visit Patients found to have systolic blood pressure 130 or
diastolic blood pressure 80 mmHg should have their blood
pressure confirmed on a separated day
b Patient with diabetes should be treated to a systolic blood
pressure 130 mmHg
c Patients with diabetes should be treated to a diastolic blood
pressure 80 mmHg
3 Lipid Management
a In adult patients, test for lipid disorders at least annually
and more often if needed to achieve goals In adult with low-
risk lipid values LDL 100 mg/dl, HDL 50 mg/dl, and
triglycerides 150 mg/dl, repeat lipid assessments every 2
years
b In children 2 years of age, perform a lipid profile after
diagnosis of diabetes and when glucose control has been
established
i Type 1 diabetes: Begin prior to puberty, if positive
family history of CVD or if family history is unknown,
and at puberty, if family history is known and is negative
i Type 2 diabetes: Begin at diagnosis, regardless of
pubertal status
PROCEDURE continued:
If lipid values are considered low risk, repeat lipid
profile every 2-5 years based on CVD risk status
4 Nephropathy
a Perform an annual test for the presence of microalbuminuria in
type 1 diabetic patients with diabetes duration of 5 years and
in all type 2 diabetic patients, starting at diagnosis
5 Diabetic Retinopathy
a Adults and adolescents with type 1 diabetes should have an
initial dilated and comprehensive eye examination by an
ophthalmologist or optometrist within 3-5 years after the onset
of diabetes
b Patients with type 2 diabetes should have an initial dilated and
comprehensive eye examination by an ophthalmologist or
optometrist shortly after the diagnosis of diabetes
c Annually,
subsequent repeat examinations for type 1 and type 2
diabetic patients should be performed by an ophthalmologist or
optometrist; who is knowledgeable and experience in diagnosing
the presence of diabetic retinopathy and is aware of its
management Less frequent exam every 2-3 years may be
considered with the advice of an eye care professional in the
setting of a normal eye exam Examinations will be required
more frequently if retinopathy is progressing
d When planning pregnancy, women with preexisting diabetes should
have a comprehensive eye examination and should be counseled on
the risk of development and/or progression of diabetic
retinopathy Women with diabetes who become pregnant should
have a comprehensive eye examination in the first trimester and
close follow-up throughout pregnancy and for 1 year postpartum
This guideline does not apply to women who develop GDM because
such individuals are not at increased risk for diabetic
retinopathy
PROCEDURE continued:
6 Foot Care
a All
individuals with diabetes should receive an annual foot
examination to identify high-risk foot conditions This
examination should include assessment of protective sensation,
foot structure and biomechanics, vascular status, and skin
integrity
b Patients with one or more high-risk foot conditions should be
evaluated more frequently for the development of additional risk
factors
i Peripheral neuropathy with loss of protective sensation
ii Altered biomechanics in the presence of neuropathy
iii Evidence of increased pressure erythema, hemorrhage under a callus
iv Bony deformity
v Perpheral vascular disease decreased or absent pedal pulses
vi A history of ulcers or amputation
vii Severe nail pathology
c Patients with neuropathy should have a visual inspection of
their feet at every visit with a provider
d Evaluation of neurological status in the low-risk foot should
include a quantitative somatosensory threshold test, using the
Semmes-Weinstein 507 10-g monofilament
e The skin should be assessed for integrity, especially between
the toes and under the metatarsal heads The presence of
erythema, warmth, or callus formation may indicate areas of
tissue damage with impending breakdown Bony deformities,
limitation in joint mobility, and problems with gait and balance
should be assessed
Source:improvingchroniccare.org
