Diabetes

Diabetes mellitus is one of the most common chronic diseases among American adults. These expenditures can be attributed to long-term complications resulting from diabetes. Some of the most significant long-term complications include blindness, renal failure and diffuse cardiovascular disease.

Controlling diabetes is now a more attainable goal because of the increased availability of effective medications and insulin regimens. In an effort to facilitate better diabetes control, national medical organizations such as the American Medical Association and the American Academy of Family Physicians establish guidelines for the standard of care for diabetes. To date, such standards of care for the diabetic patient include: regular glycosylated hemoglobin testing (A1C), annual fasting lipid profiles, regular urine testing for microalbuminuria and blood pressure control targets of under 140/90.

The following indicators provide performance minimums for the quality of care delivered to diabetic patients in Arkansas and across our nation:

  • Annual A1C testing
  • Biennial testing of lipid profile
  • Biennial retinal eye exam

What's new

Preventive health partnership health card kit

The American Cancer Society, American Diabetes Association and American Heart Association created a “health test card” designed for use in a clinical setting to facilitate communication between a patient and a provider about recommended health tests and to increase the number of people being screened for chronic diseases.

Each kit contains male and female health test cards, an interactive piece intended to be used in a clinical setting to facilitate an exchange between a patient and a provider in an effort to: 1) increase a patient’s knowledge of appropriate screenings; 2) increase the public’s understanding about the clinical role for prevention; and 3) increase the number of people being screened.  The care contains health test recommended for average risk adults by the American Cancer Society, American Diabetes Association and American Heart Association. In addition each kit contains: 1) a health card point of service display stand, used to keep cards organized within an office setting; 2) health card take-home tear-away pads, which contain the same basic information as the health cards and allow clinicians to give patients a “sheet” to take home instead of the health cards; and 3) a health card wall-mount poster, which is a replica of the tear-away pad to hang in the clinician office/exam room.

These materials are free to clinician offices, although actual shipping and handling fees do apply. To order the health cards and supporting materials, please visit www.everydaychoices.org/card.  This site also has links to technical assistance and additional patient-centered materials developed by the three organizations. Please contact the Preventive Health Partnership at cardsupport@cancer.org or 866-931-1082 for questions or comments.

Strategies for success

 

American Diabetes Association screening recommendations

Glycemic control

  • Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). The A1C goal for patients in general is <7%.
  • Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals.
  • Use of point-of-care testing for A1C allows for timely decisions on therapy changes when needed.

Hypertension/blood pressure control

  • Blood pressure should be measured at every routine diabetes visit. Patients found to have systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg should have blood pressure confirmed on a separate day.
  • Treat and maintain a blood pressure <140/90 mmHg in patients with diabetes.

Lipid management

  • In adult patients, test for lipid disorders at least annually and more often if needed to achieve goals. In adults with low-risk lipid values (LDL<100mg/dl, HDL>50mg/dl, and triglycerides <150mg/dl), lipid assessments may be repeated every two years.

Nephropathy screening

  • Perform an annual test for the presence of microalbuminuria in type 1 diabetic patients with diabetes duration of >5 years and in all type 2 diabetic patients, starting at diagnosis and during pregnancy.
  • Serum creatinine should be measured at least annually for the estimation of glomerular filtration rate (GFR) 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 chronic kidney disease.

Retinopathy screening

  • Patients with type 1 and type 2 diabetes should have a dilated retinal exam annually.

Improving patient care and office systems

  • Develop and implement a checkpoint system to identify diabetic patients.
  • Use visual reinforcement such as colored chart labels.
  • AFMC can assist with selection and implementation of health information technology to assist with preventive care/chronic management of the diabetic patient population.
  • Minimize “missed opportunities” to monitor diabetes when diabetic patients present with other acute symptoms.
  • Talk with your patients about diabetes:
    • Emphasize and educate patients on the importance of diabetes management to prevent other complications.
    • Open communication: Tell patients what to expect and provide support.
  • Utilize AFMC’s diabetes chart labels to remind office staff about core management components.
  • Provide AFMC’s educational intervention tools to support patient teaching.