Standards of Care: Prevention of Complications
Do At Every Visit:
blood pressure (adult target <130/80).
self-monitored blood glucose (SMBG) values, and assess client’s
ability to use data for pattern management.
for symptoms associated with diabetes-related complications.
physical activity, lifestyle changes, and self-management skills.
referral for medical nutrition therapy, diabetes self-management education,
and/or psychosocial assessment if needed.
on smoking cessation, if indicated.
regular use of low dose aspirin therapy for the prevention of CVD, unless
inspect feet. (The practice of foot exams at every office visit has
been shown to reduce the rate of amputations by 50%).
- A1C (quarterly
if client is not meeting goals).
- Refer for dental
- Lipid profile
(every 2 years if normal).
- Serum creatinine
and calculated GFR in adults ; urinalysis for protein, ketones, sediment,
and if negative for protein microalbumin.
- Refer for dilated
eye exam by ophthalmologist or specially trained optometrist (if normal,
an eye exam may be advised every 2-3 years).
- Comprehensive foot
exam, including monofilament testing
- Influenza vaccination.
- Pneumococcal vaccination
(usually only once, repeat if over 65 or immunocompromised and last
vaccination was more than 5 years ago).
Diabetes Self-Management Education for Persons with Diabetes
- Client and family
education, following the National Standards for Diabetes Self-Management
nutrition plan and instructions, ideally with a registered dietitian.
instructions and guidelines.
- Medication review
(including prescription, non-prescription and herbal).
for lifestyle changes (meal planning, physical activity, smoking cessation).
- Establishment of
short and long term goals.
- Podiatry consultation,
or specialized services, if needed.
- Dental hygiene.
- Referral for dilated
- Women of childbearing
age-discussion of need for optimal blood glucose control prior to conception
and family planning.
- Agreement on continuing
support, follow-up, and return appointments.
- Instructions on
when to contact the health care team.
1 For children with
type 1 who are over age 12: at diagnosis, once blood glucose is under
control. If normal, then every 5 years until age 18 (then annually).
Children with type 2: at diagnosis when blood glucose is under control.
If normal, repeat every 2 years.
2 Check creatinine in children if proteinuria is present
3 For type1: only after they have had diabetes for at least 5 years.
4 For type 1: within 3-5 years of onset of diabetes, then annually