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Basic Guidlines for Diabetes Care
The following is a list developed by the California Diabetes Control Program and the Diabetes Coalition of California detailing the specifics of good diabetes care. This list can be used to illustrate to your HMO the level of care essential to maintaining your good health, and its financial incentive to provide you with these services.
The guidelines are intended for use by primary care professionals. One or more of the following criteria were used for inclusion of an item in the guidelines:
- Published evidence demonstrated either the efficacy or the effectiveness of the item.
- Published studies on cost-identification, cost-effectiveness or cost-benefit analysis of an item demonstrated favorable results.
- A preponderance of expert opinion held that the item is considered to be essential to the care of persons with diabetes.
Blood pressure, Weight (for children add Height; plot on Growth Chart)
Every visit. Blood Pressure target goal < 130/85 (children: < 90th percentile age standard). Children: normal weight for height (see standard growth charts).
Foot Exam (for adults)
Thorough visual inspection every "diabetes visit;" pedal pulses and neurological exam annually.
Dilated Eye Exams
For people with type 1: Five years after diagnosis, then every year by a trained expert.
For people with type 2: Shortly after diagnosis, then every year by a trained expert.
HbA1c
Quarterly, if treatment changes or is not meeting goals; one to two times per year if treatment is stable. Target goal: < 7.0 % or < 1 % above lab norms. For children: Modify if necessary to prevent significant hypoglycemia.
Microalbuminuria
For people with type 1: Five years after diagnosis, then every year.
For people with type 2: Begin at diagnosis, then every year.
Blood Lipids (for adults)
On initial visit, then annually. Target Goals: Cholesterol, Triglycerides (in mg/dL) < 200; LDL < 130 (unless coronary heart disease is present, then < 100); HDL > 35.
Management Principles and Complications
Understanding diabetes, medications, glucose self-monitoring, hypo/hyperglycemia, chronic complications, psycho-social assessment (special attention needed for adolescents); at initial visit and in follow-up visits. For children: When appropriate for developmental stage.
Self Glucose Monitoring
For people with type 1: Typically test four times a day; others as needed to meet treatment goals.
Medical Nutrition Therapy
At initial visit: Assess conditions/needs, assist patient in setting nutrition goals. In follow-ups: Assess progress toward goals and identify problem areas; to be done by a trained expert.
Physical Activity - Assess patient at initial visit and prescribe physical activity based on needs/conditions at initial visit and in follow-ups.
Weight Management - Must be individualized for each patient at initial visit and follow-ups.
Preconception Counseling and Management
Consult with high-risk perinatal programs where available. For adolescents: Special counseling is advisable beginning at puberty.
Pregnancy Management
Same as above.
Smoking Cessation
Screen, advise and assist at initial visit, then annually.
Vaccinations
Influenza and Pneumococcal per Center for Disease Control recommendations.
These guidelines are consistent with the American Diabetes Association Clinical Practice Recommendations.
These materials have been produced through the collaborative efforts of the Diabetes Coalition of California and the California Diabetes Control Program — 1997
* These guidelines should be used in conjunction with the Explanatory Notes. For a copy of these guidelines, the explanatory notes and a list of references write to:
California Department of Health Services
Diabetes Control Program
P. O. box 942732
Sacramento, CA 94234-7320
(916) 327-6985
Special thanks to the Diabetes Coalition of California and the California Diabetes Control Program for use of these guidelines.
Categories: A1c Test, Diabetes, Health Insurance, Low Blood Sugar, Type 2 Issues
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