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OUTPATIENT MANAGEMENT OF DIABETES
Aspect of
Care
Monitor Frequency Target
Outcome
Recommendations
Glycemic
Control
Fix font so
they all
match
HbA1c Quarterly
or
Semi-
Annual
<7% Target hemoglobin A1c (A1C) should be individualized. A reasonable goal for A1C
in relatively healthy adults with good functional status is 7% or lower. For frail, older
adults, persons with life expectancy of less than 5 years, and others in whom the risks
of intensive glycemic control appear to outweigh the benefits, a less stringent
treatment goal may be appropriate.
Obtain A1C test quarterly in persons whose therapy has changed or who are not
meeting glycemic goals. Obtain A1C test at least twice yearly if at goal and who have
stable glycemic control. Use of Point of Care Testing for A1C allows for timely
decisions on therapy changes when needed.
Lipids LDL Annual <100 mg/dl
Lifestyle modification focusing on the reduction of fat and cholesterol intake, weight
loss (if indicated), and increased physical activity has been shown to improve the
lipid profile in persons with diabetes. In persons without overt CVD over the age of
40 years, statin therapy to achieve an LDL reduction of 30-40% regardless of
baseline LDL is recommended. In persons with overt CVD, all persons should
receive statin therapy to achieve an LDL reduction of 30-40%.
Retinopathy Dilated-eye
examination
by an
Eye-Care
Specialist
Annual Adults with type 1 diabetes should have an initial dilated and comprehensive eye
exam performed by an eye care specialist within three to five years after the onset of
diabetes. Persons with type 2 diabetes should have an initial dilated and
comprehensive eye exam shortly after the diagnosis of diabetes. Subsequent dilated
comprehensive eye examinations for persons with type 1 and type 2 diabetes should
be performed annually.
Nephropathy Micro-
albumin
Serum
Creatinine
Annual
Perform an annual test for the presence of microalbuminuria in persons with type 1
diabetes with diabetes duration of ≥ 5 years and in all persons with type 2 diabetes
starting at diagnosis. In persons with any degree of CKD, protein intake should be
limited to RDA (0.8g/kg) to reduce the risk of nephropathy.
Serum Creatinine should be measured at least annually for the estimation of
glomerular filtration rate in all adults with diabetes regardless of the degree of urine
albumin excretion. The serum creatinine alone should not be used as a measure of
kidney function but instead used to estimate GFR and stage the level of CKD.
Hypertension Blood
Pressure
Each visit . If patient has hypertension, then the target blood pressure should be less than 130/80
if it is tolerated. Because older adults may have reduced tolerance for blood pressure
reduction, hypertension should be treated gradually to avoid complications.
Foot Care Foot exam Annual All persons with diabetes should receive an annual foot examination to identify high-
risk foot conditions. This examination should include assessment of protective
sensation, foot structure and biomechanics, vascular status, and skin integrity.
Persons with neuropathy should have a visual inspection of their feet every office
visit by a health care professional.
This table of suggested guidelines has been developed from the American Diabetes Association: 2007 Standards of Medical Care
in Diabetes:
Diabetes Care 29: S4-S42, 2006.
It is intended to provide guidance to practitioners to reduce risks associated with diabetes,
increase awareness of diabetes, and to optimize disease management. It contains guidelines only and should never supersede
clinical judgment. The practitioner in conjunction with the patient should decide whether these or other recommended services
should be performed more or less frequently. Clinical judgment and discussion should be documented in the medical record
Utilization Management Committee will review Guidelines for new scientific evidence or national standard changes prior to
distribution to Providers annually. 9/27/2007
