Strategies for success
American Diabetes Association screening recommendations
- 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.
- 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.
- 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.
- 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.
National Diabetes Education Program - 4 Steps to Manage Your Diabetes for Life