The Practical Aspects

Clinical Guidelines for Your Diabetes Care

The following guidelines were adapted from the American Diabetes Association's clinical standards for patients with diabetes mellitus. Your progress should be assessed at regular visits to your physician and/or at least every six (6) months. Here are the ADA's suggestions for what should happen on those visits:

1. Hemoglobin A1c (HBA1c) Measurement

• Frequency:
  1. quarterly if treatment changes or if patient is not meeting goals
  2. semi-annually if stable and is meeting treatment goals
• Goals should be adjusted for patient specific factors such as:
  
  • capacity to understand and follow treatment recommendations
  • patient's risk for severe hypoglycemia
  • whether the patient is very young or old age, or has end-stage renal disease, advanced cardiovascular or cerebral vascular disease, or other coexisting diseases that will materially shorten life expectancy
• Patient with values <7.0% are at lower risk of diabetic complications

2. Eye Examinations

• Without prior history of retinal pathology: dilated retinal exam annually
• Positive retinal exam: refer to an ophthalmologist experienced in management of diabetic retinopathy

3. Blood Pressure Screening

• Goal <130/80

4. Microalbuminuria

• Annual screening in type 1 and 2 adults with no known diabetic kidney problems

5. Lipid Screening

• A fasting lipid profile should be performed annually for adult diabetic patients. Children greater than two years of age should have a lipid profile performed once glucose control has been established
• Goal LDL-C value is £ 100mg/dl
• Use National Cholesterol Education Program (NCEP) guidelines for treatment advice

6. Aspirin Prophylaxis

• Daily intake of aspirin has been shown to reduce cardiovascular events in patients with diabetes
• Use enteric-coated aspirin in doses of 80-325 mg/day
• Not recommended for patients under the age of 21 years

7. Foot Examinations

• Examination of legs and feet, including between toes and the posterior aspect of the heels, should be performed at each visit.
• A comprehensive vascular, neurological, musculoskeletal, and skin/soft tissue evaluation should be performed annually; more often in patients with high-risk foot conditions

8. Vaccinations

• Annual influenza vaccine
• Pneumococcal vaccine, if not previously administered, for adults upon diagnosis of diabetes