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Intervention Strategies

The following recommendations for diabetes care and management are based on the American Diabetes Association Standards of Medical Care.

Assess current practice criteria used for diabetes patients
Assess whether current diabetes management and treatment assure compliance with the American Diabetes Association Standards of Medical Care
Establish an accurate diagnosis of diabetes
Assess for risk factors and treat accordingly
Diabetic diet, and activity levels should be discussed, counseled and encouraged.
Instruction in Self Monitoring Blood Glucose (SMBG) and accurate diaries should be kept
Interim history should include, ER visits, hospitalizations, possible hypo-hyper glycemic, cardiac, peripheral vascular, renal, opthomalogical, and distal neurological symptoms
Each visit should include a review of SMBG diaries to help identify long-term control, compliance, and symptomatology
Each visit should include a review of all medications taken and compliance should be discussed and encouraged
Hemoglobin A1c should be performed at least 2 times a year in patients meeting treatment goals. ADA goal is <7.0
Blood pressure should be assessed at each visit systolic BP > or = 130 or diastolic BP >or= 80 should have BP confirmed on a different day. Goals are a systolic BP < 130 and diastolic BP < 80
A lipid profile should be performed at least Annually including Cholesterol, Triglycerides, LDL and HDL in patients with low risk lipid values (LDL < 100 HDL > 50 and Triglycerides, 150) repeat lipid assessment every 2 years
Institution of lifestyle modifications for lipid control
If lifestyle modifications are not successful pharmacological therapy is required including a statin for LDL control
Aspirin therapy is indicated in patients over age 21 with no contraindications and an increased risk of cardiovascular disease
Encourage smoking cessation
An annual test for presence of Microalbuminuria in type I Diabetics at 5 years after diagnosis and Type II Diabetes at the time of diagnosis
In hypertensive patients with any degree of albuminuria an ACE inhibitor or ARB agent is indicated to delay the progression of nephropathy
Opthamalogical referral for dilated retinal exams should be performed on an annual basis
Every diabetic should receive an annual foot exam including inspection, vascular evaluation and sensory evaluation preferably using Semmes Weinstein 5.07 monofilament.
At least one lifetime pneumonia vaccine should be offered and provided in patients over 6 months of age
An annual influenza vaccine should be offered and provided in patients over 6 months of age