Fig. 1. IDC Program Clinical Guidelines for glycemic control (excerpt)

Goals for glycemic control:

If hemoglobin A1c is used to assess long-term glycemic control, the target goal is 1-2% greater than the upper limit of normal for the lab where the test was performed. Individual needs should determine the appropriate goal for any given patient. If an analogous test of glycemic control is used, the appropriate equivalent value should be used.

Interval to monitor long-term glycemic control:

Once goals for glycemic control have been attained, testing should be performed every 3-4 months for those requiring insulin, and every 6-12 months for patients not requiring insulin. The test should be performed more frequently if the glycemic control goals have not been met, if the patient's diabetes medications are being altered, or if the therapeutic goal is to attain tight control.

Self-monitoring of blood glucose:

All diabetic patients should be offered patient education on self-monitoring of blood glucose. This should be documented in the medical record. The goal of self-monitoring should be to maintain fasting blood glucose values of between 80 and 120 mg/dL, and to aim for a 2-hour post-prandial value of < 180 mg/dL, or as individualized to each patient's situation. If preprandial values are > 150 mg/dL or post-prandial values are > 200 mg/dL, the physician and/or health care professional should reassess the need for tighter control. Patient success with self-management should be reviewed and reassessed at least annually. When appropriate, education in self-monitoring should be reoffered to patients.

 

Fig. 2. IDC Program Clinical Guidelines for renal disease (excerpt)

Patients without known renal disease should be screened annually, by first morning dipstick or equivalent measure, for microalbumin in the urine. Those patients (either Type 1 or 2, normotensive or hypertensive) who test positive for microalbumin on at least two occasions should be treated with an angiotensin-converting enzyme (ACE) inhibitor medication, unless contraindicated.

 

Fig. 3. IDC Program Clinical Guidelines for podiatric screening (excerpt)

Visual inspection of the feet should be performed at all primary care visits. A full foot examination (including visual inspection for ulcers, cracks, calluses, and pressure points; palpation for pulses; and sensory testingpreferably with 10 g monofilament) should be performed at least annually or as clinically appropriate at each diabetes encounter. Findings should be documented in the medical record. Patients with exams that reveal one or more abnormalities should be referred if appropriate. Once a patient has demonstrated a foot abnormality they should receive a visual inspection of the feet every 3-4 months.