Diabetes Outreach Network
QUICK REFERENCE GUIDE TO DIABETES FOR HEALTH CARE PROVIDERS

Chapter 2
Diabetes Standards of Care: Prevention of Complications

To Do At Every Visit:

• Check blood pressure (adult target <130/80).
• Measure weight.
• Review self-monitored blood glucose (SMBG) values, and assess client’s ability to use data for pattern management.
• Review/adjust medications.
• Look for symptoms associated with diabetes-related complications.
• Assess physical activity, lifestyle changes, and self-management skills.
• Consider referral for medical nutrition therapy, diabetes self-management education, and/or psychosocial assessment if needed.
• Counsel on smoking cessation, if indicated.
• Recommend regular use of low dose aspirin therapy for the prevention of CVD, unless contraindicated.
• Visually inspect feet. (The practice of foot exams at every office visit has been shown to reduce the rate of amputations by 50%).

Twice a year:

• A1C (quarterly if client is not meeting goals).
• Refer for dental exam.

Annually:

• 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.

Lifetime:

• 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 Education.
• Individualized nutrition plan and instructions, ideally with a registered dietitian.
• Self-monitoring instructions and guidelines.
• Medication review (including prescription, non-prescription and herbal).
• Recommendations 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 eye exam.
• 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.

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  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

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References: American Diabetes Association (2006). Clinical Practice Recommendations. Diabetes Care, Vol 29 (1).

The National Diabetes Education Program Publication No. NDEP-12..