Additional Resources

• Diabetes Links

Foot Care

• Bureau of Primary Health Care LEAP site
• Monofilament Application Instructions for Providers

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