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

2. Clinical Practice Recommendations

To Do At Every Visit:

• Check blood pressure
• Assess hypoglycemia - frequency, possible causes, and severity
• Review self-monitored blood glucose values
• Discuss changes patient has initiated in treatment plan
• Assess problems with adherence
• Look for symptoms associated with diabetes related complications
• Review current medications and other medical and psychosocial concerns
• Assess lifestyle changes
• Visually inspect feet*

* The practice of foot exams at every office visit has been shown to reduce the rate of amputations by 50%.

General:	Initially and at least annually	at least quarterly
History and Physical		o
Height and weight
Blood Pressure		at every visit
Sexual maturation (prepubertal patients)		o
Examinations:
Dilated eye exam*1 (by ophthalmologist or specially trained optometrist)		o
Comprehensive foot exam, including test for loss of protective sensation		o
Dental exam		twice a year
Laboratory Evaluations:
HbA1c		2-4 X per year
Fasting plasma glucose
Lipid profile*2		o
Urinalysis (protein, glucose, sediment)*3 If negative for protein, check for microalbumin.		o
Microalbuminuria (timed specimen or albumin/creatinine ratio)*3		o
EKG (adults only)	as indicated	o
Serum creatinine*4		o
Thyroid function*5 (if they have a high incidence of thyroid dysfunction)	as indicated	o

Exceptions and Notes:

1. Type 1: within 3-5 years of onset of diabetes, then annually.
2. Children with type 1 over age 12: at diagnosis when 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 under control. If normal, repeat every 2 years.
3. Type 1: only after puberty has started and have had diabetes for at least 5 years.
4. Children: only ones with proteinuria.
5. Thyroid problems are more prevalent with type 1 diabetes.

Management Plan for People with Diabetes

• Establishment of short and long term goals.
• Individualized nutrition plan and instructions, ideally with a registered dietitian.
• Medication review (include prescription, non-prescription and herbal medications).
• Patient and family education, following the National Standards for Diabetes Self-Management Education.
• Podiatry consultation, or specialized services, if needed.
• Agreement on continuing support, follow-up, and return appointments.
• Instructions on when to contact the health care team.
• Dental hygiene.
• Recommendations for lifestyle changes (meal planning, activity, smoking cessation).
• Self monitoring instructions and guidelines.
• Women of childbearing age; discussion of contraceptives and need for optimal blood glucose control prior to conception.
• Referral for dilated eye exam

Reference: American Diabetes Association (2003). Clinical Practice Recommendations, 2003. Diabetes Care, Vol 26(1) p 33-50.