• Wisconsin Diabetes Advisory Group. Wisconsin essential diabetes mellitus care guidelines. Madison (WI): Wisconsin Diabetes Prevention and Control Program; 2004. Various p. [246 references]

This is the current release of the guideline.

General Recommendations/Care

• Perform diabetes-focused visit

  Frequency

  • Type 1*: Every 3 months
  • Type 2*: Every 3-6 months

    * Consider more often if A1c >7.0% and/or complications exist

• Review management plan, assess problems and goals

  Frequency

  • Each focused visit; revise as needed
• Assess physical activity

  Frequency

  • Each focused visit
• Assess nutrition/weight/body mass index (BMI)/growth

  Frequency

  • Each focused visit

Self-Management Education

• Refer to diabetes educator, preferably a certified diabetes educator (CDE); curriculum to include the ten key areas of the national standards for diabetes self-management education

  Frequency

  • At diagnosis, then every 6-12 months, or more as needed

Medical Nutrition Therapy

• Refer to registered dietician, preferably a certified diabetes educator; to include areas defined by the American Dietetic Association's Nutrition Practice Guidelines.

  Frequency

  • Type 1: At diagnosis; then, if age <18, every 3-6 months; if age >18, every 6-12 months.
  • Type 2: At diagnosis; then every 6-12 months or more as needed

Glycemic Control

• Check A1c (see Algorithm 1 in original guideline document)

  Goal: <7.0% or <1% above lab norms

  Frequency

  • Type 1: Every 3 months
  • Type 2: Every 3-6 months
• Review goals, medications, side effects, and frequency of hypoglycemia

  Frequency

  • Each focused visit
• Assess self-blood glucose monitoring schedule

  Frequency

  • Each focused visit, 2-4 times/day, or as recommended

Cardiovascular Care

• Check lipid profile

  Adult goals: Total Cholesterol <200 mg/dL
  Triglycerides <150 milligrams(mg)/dL
  High-density lipoprotein (HDL) >40 mg/dL (men)
  HDL >50 mg/dL (women)
  Non-HDL (Cholesterol) <130 mg/dL
  Low-density lipoprotein (LDL) <100 mg/dL (optimal goal)
  Low-density lipoprotein <70 mg/dL (for very high risk)

  Frequency

  • Children: If >2 years, after diagnosis and once glycemic control is established. Repeat annually if abnormal. Follow National Cholesterol Education Program (NCEP III) guidelines.
  • Adults: Annually. If abnormal, follow NCEP III guidelines.
• Blood pressure

  Adult goal: <130/80 mmHg

  Pediatric goal: below 90% of ideal for age

  Frequency

  • Each focused visit
• Assess smoking status

  Frequency

  • Each visit; if smoker, counsel to stop; refer to cessation
• Start aspirin prophylaxis (unless contraindicated)

  Frequency

  • Age >40 with diabetes; Age <40, individualize based on risk

Kidney Care

• Check albumin/creatinine ratio using a random urine sample, also called urine microalbumin/creatinine ratio (see Algorithm 2 in the original guideline document)

  Frequency

  • Type 1: Begin with puberty or after 5 years duration, then annually
  • Type 2: At diagnosis, then annually
• Check serum creatinine

  Frequency

  • At diagnosis, then annually
• Perform routine urinalysis

  Frequency

  • At diagnosis, then as indicated

Eye Care

• Perform dilated eye exam by an ophthalmologist or optometrist

  Frequency

  • Type 1: If age >10, within 3-5 years of onset, then annually
  • Type 2: At diagnosis, then annually; two exceptions exist (see Section 7 in the original guideline document)

Foot Care

• Inspect feet, with shoes and socks off

  Frequency

  • Each focused visit; stress need for daily self-exam
• Perform comprehensive lower extremity exam

  Frequency

  • Annually, with monofilament

Oral Care

• Perform oral health screening

  Frequency

  • At diagnosis, then each focused visit
• Advise dental exam by general dentist or periodontal specialist

  Frequency

  • At diagnosis, then every 6 months (if dentate) and every 12 months (if edentate)

Emotional/Sexual Health Care

• Assess emotional health; screen for depression

  Frequency

  • Each focused visit
• Assess sexual health concerns

  Frequency

  • Each focused visit

Immunizations

• Provide influenza vaccine

  Frequency

  • Annually, if age >6 months
• Provide pneumococcal vaccine

  Frequency

  • Once; then per Advisory Committee on Immunization Practices

Preconception and Pregnancy Care

• Provide preconception counseling/assessment

  Frequency

  • 3-4 months prior to conception*
• Assess contraception/discuss family planning

  Frequency

  • At diagnosis and each focused visit*
• Screen for gestational diabetes

  Frequency

  • At 24-28 weeks gestation or sooner if high risk*

    * Consider referring to provider experienced in care of diabetic women during pregnancy.

Screening for Pre-diabetes and Diabetes

• Perform fasting plasma glucose test or oral glucose tolerance test (see Algorithm 6 in the original guideline document)

  Frequency

  • Test all people >age 45; if normal and person has no risk factors, retest in 3 years

Screening for Pre-diabetes and Diabetes

Test all people >45 years for pre-diabetes and diabetes. If screening results are normal and person has no risk factors, re-testing should occur at 3-year intervals. Screen at a younger age or more often if the person has one or more risk factors from the following list:

1. Body mass index >25 kilograms/m²
2. Sedentary lifestyle
3. Prior history of pre-diabetes/glucose intolerance
4. Race/ethnicity (e.g., African-Americans, Hispanic-Americans, Native Americans, Asian-Americans, and Pacific Islanders)
5. Family history of diabetes in one or more first-degree relatives
6. History of hypertension (>140/90 mmHg)
7. History of vascular disease
8. History of dyslipidemia: HDL <35 mg/dL and/or a triglyceride level >250 mg/dL
9. Markers of insulin resistance: (e.g., acanthosis nigricans and/or waist circumference >40 inches in men and >35 inches in women)
10. History of polycystic ovary syndrome (PCOS)
11. History of gestational diabetes mellitus (GDM) in women or delivery of a baby weighing more than nine pounds at birth

Diagnosis of Pre-diabetes and Diabetes (2004 Criteria)

Fasting Plasma Glucose (FPG)

How Performed: Blood glucose is measured after at least an 8 hour fast

Normal: <100 mg/dL

Pre-diabetes (impaired fasting glucose [IFG]): 100-125 mg/dL

Diabetes Mellitus: >126 mg/dL*

Oral Glucose Tolerance Test (OGTT)

How Performed: 75-gram glucose load (drink) is ingested after at least an 8-hour fast; blood glucose is measured at 2 hours

Normal: <140 mg/dL

Pre-diabetes (impaired glucose tolerance [IGT]): 140-199 mg/dL

Diabetes Mellitus: >200 mg/dL

Random/Casual Plasma Glucose (with symptoms)

How Performed: Blood glucose is measured at any time regardless of eating

Diabetes Mellitus: >200 mg/dL (with symptoms)* #

*Test must be confirmed by repeating on a different day

# It is not appropriate to have a person eat a meal and then draw a random glucose two hours after.

Clinical algorithms are provided in the original guideline document for:

• Type 2 Diabetes: Glycemic Control
• Screening and Initial Recommendations for Diabetic Kidney Disease (Microalbuminuria and Macroalbuminuria)
• Diabetic Foot Disorders ULCER: A Clinical Practice Pathway
• Diabetic Foot Disorders INFECTION: A Clinical Practice Pathway
• Diabetic Foot Disorders CHARCOT FOOT: A Clinical Practice Pathway
• Screening for Pre-diabetes and Diabetes

The recommendations are based on results of clinical trials, accepted science, and expert opinions.

• Wisconsin Diabetes Advisory Group. Wisconsin essential diabetes mellitus care guidelines. Madison (WI): Wisconsin Diabetes Prevention and Control Program; 2004. Various p. [246 references]

Not applicable: The guideline was not adapted from another source.

2004 Dec

Wisconsin Diabetes Prevention and Control Program - State/Local Government Agency [U.S.]

Centers for Disease Control and Prevention (CDC), Division of Diabetes Translation

Guidelines Work Groups and Diabetes Advisory Group

Workgroup Members: Mary Anderson, Wisconsin Association for Perinatal Care, Preconception and Prenatal Care Committee; Ruth Ann Berkholtz, MSSW, BCD, Licensed Clinical Social Worker, Madison Psychiatric Associates; Dory Blobner, RN, MS, CDE, Diabetes Education Coordinator, Dean Clinic; Mary Bruskewitz, RN, MS, Wisconsin Nurses Association, Capitol Area and Surrounding Communities Association of Diabetes Educators (CASCADE); Jenny Camponeschi, MS, Diabetes Prevention and Control Program, Wisconsin Department of Health and Family Services; Pat Celek, RN, CDE, Aurora Health Care; Ann Conway, RN, MS, MPA, Executive Director, Wisconsin Association for Perinatal Care; Susan Davidson, MD, St. Mary's Hospital; Sarah Dillenbeck, RD, CD, CDE, UW Medical Foundation; Robert Draeger, Retired Teacher; Sherree Drezner, ACSW, LCSW, University of Wisconsin Hospital and Clinics; Krista Eastman, BA, Consultant; April Eddy, RN, CNS, CDE, Meriter Hospital, Perinatal Clinic; Ann Ebert, PharmD, Wisconsin Association for Perinatal Care, Preconception and Prenatal Care Committee; Diane Elson, MD, University of Wisconsin Hospital and Clinics; Joan Fisher, RN, CCM, MercyCare Insurance Company; Irene Golembiewski, MA, Media Solutions, University of Wisconsin Medical School; Margo Grady, MS, CGC, Wisconsin Association for Perinatal Care, Chair, Preconception and Prenatal Care Committee Meriter Hospital; Rosalyn Haase, RD/CD, CDE, MPH, BC-ADM, Wisconsin Dietetic Association; Peter G. Hanson, MD, Peter Christiansen Health Center; Dee Helgeson, RN, CDE, Reedsburg Physicians Group; Sonja Henry, MS, CGC, Wisconsin Association for Perinatal Care, Preconception and Prenatal Care Committee; Dan Hopfensperger, Immunization Program, Wisconsin Department of Health and Family Services; Sue Hugl, RN, BSN, CDE, Froedtert and Medical College Diabetes Care Center; Anthony M. Iacopino, DMD, PhD, Wisconsin Dental Association, Marquette University School of Dentistry; Jonathan B. Jaffery, MD, University of Wisconsin Medical School, Department of Medicine, Section of Nephrology; Kate Jaeger, Diabetes Program Assistant, Sixteenth Street Community Health Center; Mary Jenny, RN, BSN, Population Health Care Coordinator, WEA Trust; Audrey Johnson, RN, MSN, CDE, Aurora Health Care; Virginia Jordan, MS, RD, CDE, West Central Wisconsin Association of Diabetes Educators (WECWAADE); Pamela Kittleson, RPh, UW Medical Foundation; Kevin P. Kortsch, DPM, Wisconsin Society of Podiatric Medicine; Christy Kreul, Physicians Plus Insurance Corporation; Leah Ludlum, RN, BSN, CDE, Diabetes Prevention and Control Program, Wisconsin Department of Health and Family Services; Steven B. Magill, MD, PhD, St. Luke's Medical Center, Aurora Health Care; Glenna McWilliams, Board Certified Pedorthist, National Pedorthic Services, Inc.; Melissa Meredith, MD, University of Wisconsin Hospital and Clinics; Kristi Michalowski, MS, CPHQ, MetaStar, Inc.; Kyle Mounts, MD, Neonatologist, Newborn Care Physicians of Southeast Wisconsin; Jane Nelson Worel, RN, MS, University of Wisconsin Hospital and Clinics, Preventive Cardiology Program; Paul M. Reber, DO, Dean Medical Center; Chandra Reddy, MD, MPH, Great Lakes Inter-Tribal Council, Inc.; Thomas Repas, MD, Affinity Medical Group, Department of Endocrinology; Tim Ringhand, RN, MPH, Diabetes Prevention and Control Program, Wisconsin Department of Health and Family Services; Fredric J. Romm, MD, MPH, Medical College of Wisconsin; Elaine Rosenblatt, NP, University of Wisconsin Hospital and Clinics; David A. Scheidt, OD, Wisconsin Optometric Association; Eva Scheppa, RN, BSN, Family Health Center of Marshfield, Marshfield Clinic; Julie Schuller, MD, MPH, Medical Director, Sixteenth Street Community Health Center; Elizabeth Spencer, RD, MS, CDE, UW Health Eau Claire Family Medicine Clinic, University of Wisconsin, Department of Family Medicine; Thomas S. Stevens, MD, Wisconsin Academy of Ophthalmology; Alisa Sunness, RD, CDE, UW Medical Foundation; Julie Thiel, RPh, Pharmacy Society of Wisconsin; Gail Underbakke, MS, RD, University of Wisconsin Hospital and Clinics, Preventive Cardiology Program, University of Wisconsin Medical Foundation, Behavioral Health Consultation Services; William Weis, DPM, FACFAS, DWS, Wisconsin Society of Podiatric Medicine; Jennifer Wilen, MPH, Learning Coordinator, Wisconsin Association for Perinatal Care; Susan Williams, RN, CDE, Nurse Diabetes Educator, St. Francis Hospital; Kara Yaeger, RN, CDE, University of Wisconsin Hospital and Clinics

Not stated

This is the current release of the guideline.

This NGC summary was completed by ECRI on July 22, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.