2009 Arizona Adult Diabetes Practice Guidelines
Every Visit
| Take interval history |
Review glucose testing log, hypoglycemic episodes and tobacco use
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Measure blood pressure
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BP goal is 130/80 mmHg
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Obtain weight
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Weigh and calculate BMI. Consider measuring waist circumference
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Perform interval foot exam
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Inspect skin for signs of pressure areas and breakdown
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| Advise, review, adjust and/or administer medications
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- Glocose-lowering medications
- HTN therapy includes ACEI/ARB; diuretic type based on GFR
- ACEI/ARB for nephropathy
- Lipid-lowering drugs as needed
- Aspirin prophylaxis, age>40 or with CVD risk factors-weigh risk/benefit
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Quarterly to semi-annually
| Test A1C |
- Test 4 times per year; two times per year if in good control
- General goal 7%
- Lower A1C (close to 6%) may be appropriate for individuals with a short duration of diabetes, long life expectancy and no significant CVD. as long as hypoglycemia is avoided
- Less stringent A1C goals than the general <7% may be appropriate for individuals with advanced diabetes complications, CVD, co-morbidities, reduced life span, or significant hypoglycemia
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At least once a year
| Review patient knowledge of diabetes, nutrition, and self-management |
- Provide or refer: training in self-management, nutrition, physical activity
- Council on importance of regular dental exams
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Annually
| Perform complete foot risk assesment |
Inspect, check pulses, conduct monofilament exam |
| Perform nephropathy screen |
- For patients without known nephopathy, screen for microalbuminuria. Normal 30 mcg of albumin per mg creatine
- Measure serum creatine to estimate GFR
- If nephropathy present, treat and monitor, or refer to nephrology
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| Obtain lipid profile |
- Primary goal: LDL <100 mg/dl (LDL<70 mg/dl if CVD or high risk)
- Desirable: HDL >40 mg/dl, Triglycerides <150 mg/dl
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| Arrange retinal eye exam |
- Dilated eye exam by eye care professional
- Or exam with retinal photographs read by experienced experts
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