| General Recommendations for Care |
Perform diabetes-focused visit |
Every 3-6 months |
| Review care plan: assess goals/strengths/barriers |
Each diabetes visit, revise as needed |
| Assess nutrition, physical activity, BMI, and growth in youth |
Each diabetes visit |
| Self-Management Education (DSME) |
Refer to diabetes educator |
At diagnosis, then every 6-12 mo., or more as needed |
| Medical Nutrition Therapy (MNT) |
Refer for MNT provided by a registered dietitian |
At diagnosis and at least yearly, or more as needed |
| Glycemic Control |
Check A1C, individualize goal: e.g., < 7%, 7-8%, 8-9%, etc. |
Every 3-6 months |
| Review goals, medications, side effects |
Every diabetes visit |
| If prescribed, review SMBG data |
Every diabetes visit |
| CVD Risk Reduction |
Prescribe statin with lifestyle therapy regardless of LDL level |
Adults with CVD; age > 40 y. with ≥ 1 CVD risk factor |
Check lipid profile
LDL < 100 mg/dL (optimal goal), LDL < 70 mg/dL (for very high risk)
Non-HDL cholesterol < 130 mg/dL, < 100 mg/dL (for very high risk) |
Annually. If abnormal, follow current NCEP guidelines. |
| Assess smoking/oral tobacco use |
Each visit: Ask, Advise, Assess, Assist, Arrange |
| Aspirin therapy 75-162 mg/day (unless contraindicated) |
Known CVD/PAD; 10-year CVD Risk > 10% |
| Blood Pressure |
Check blood pressure
Individualize goal: e.g., < 130/80 mmHg, < 140/90 mmHg
Youth goal: Varies with age |
Every visit |
| Kidney Care |
Check urine albumin/creatinine ratio (UACR) for albuminuria using a random urine sample (normal < 30 mg/g; micro 30-300 mg/g; macro > 300 mg/g) |
At diagnosis, then annually |
Check serum creatinine and estimate GFR
If HTN, prescribe ACE Inhibitor or ARB unless contraindicated |
At diagnosis, then annually |
| Eye Care |
Retinal camera photo or dilated eye exam by an ophthalmologist or optometrist |
At diagnosis, then annually; or as directed by eye specialist |
| Foot Care |
Visual inspection of feet with shoes and socks off |
Each diabetes visit; stress daily self-exam |
| Perform comprehensive lower extremity/foot exam |
At diagnosis, then annually |
| Screen for PAD (consider ABI) |
At diagnosis, then annually |
| Oral Care |
Inspection of gums/teeth |
At diagnosis, then at diabetes visits |
| Dental exam by dental professional |
At diagnosis, then every 6 -12 months |
| Autonomic Neuropathy |
Assess CV symptoms; resting tachycardia, exercise intolerance, orthostatic hypotension |
At diagnosis, then annually |
| Assess GI symptoms; gastroparesis, constipation, diarrhea |
At diagnosis, then annually |
| Assess sexual health/function for men and women |
At diagnosis, then annually |
| Behavioral Health |
Assess emotional health (e.g. depression, substance abuse) |
At diagnosis, then regularly |
| Immunizations |
Influenza vaccine |
Annually |
| Pneumococcal vaccine |
Once < 65 y. Re-immunize if ≥65 y. and 1st dose given before age 65 and if vaccine was administered > 5 y. prior. |
| Hepatitis B immunization |
Unvaccinated adults < 60 y. |
| Preconception, Pregnancy, and Postpartum Care |
Ask about reproductive intentions/assess contraception |
At diagnosis, and then every visit |
| Provide preconception counseling |
3-4 months prior to conception |
| Screen for undiagnosed type 2 diabetes |
At first prenatal visit |
| Screen for GDM in all women not known to have diabetes |
At 24-28 weeks gestation |
| Screen for type 2 diabetes in women who had GDM |
At 6-12 weeks postpartum, then every 1-3 y. lifelong |
