Clinical Recommendations for Diabetes Care Standards of Care for those with Diabetes

Alabama Nurse,  Mar-May 2004  

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Alabama ranks among the top five states in the estimated prevalence of diabetes and obesity. Diabetes is the sixth leading cause of death in the state and directly contributes to the incidence of heart disease, strokes, kidney-failure, non-trauma related amputations, and adult-onset blindness. The diagnosis of Type 2 diabetes is at an all-time high and continues to rise.

It is the goal of the Alabama Department of Public Health Diabetes Prevention and Control Program and the Alabama Diabetes Advisory Council to help minimize complications in those with diabetes and to prevent as many new cases of diabetes as possible. To accomplish this, it is suggested that all healthcare providers follow the American Diabetes Association's Clinical Recommendations for Diabetes Care. According to the recommendations, a foot exam, blood pressure check, blood glucose levels and weight measurement should be conducted at each visit. A lipid profile, a urinalysis for microalbumin and serum creatinine, a dilated eye exam, and a nerve conduction study should be performed on an annual basis. The Hemoglobin Alc, a test that determines the average blood glucose for three months, should be conducted quarterly in patients experiencing changes in treatment or difficulty with blood glucose control and biannually, for those who are in good control. Since patients with diabetes are at greater risk for pneumonia and influenza, it is further recommended that they receive influenza vaccine each year and pneumonia vaccine once for lifetime immunization.

Each patient with diabetes should have an individualized management plan that is a therapeutic alliance between the patient and physician. The plan should include problem solving, behavior modification, long and short term goal setting, daily blood glucose monitoring, a process for managing acute problems, and information on any medications prescribed. It has proven beneficial for the patient to have a written copy of the plan. Specialty consultations should also be discussed and appointments made.

Another group of individuals who should be included in the treatment regimen are those who are at risk for or diagnosed with pre-diabetes. Pre-diabetes may be diagnosed with a fasting blood glucose of 100-125 mg/dl and/or an Oral Glucose Tolerance Test of 140-199 mg/dl in persons exhibiting one or more of the following risk factors: 40 years of age or older; 20% or more over ideal body weight; A blood pressure consistently higher than 140/90; abnormal lipid levels; family history of Type 2 diabetes; history of gestational diabetes; sedentary lifestyle; and certain ethnic/racial backgrounds. These individuals may, and usually do, develop diabetes within 10-15 years if prevention intervention is not initiated. Losing 5 to 7% of body weight, exercising a minimum of 30 minutes five days a week, and eating a healthy diet have been demonstrated to prevent or delay the onset of diabetes.

Additional information is available at the ADA Web site, www.diabetes.org/for-health-professionals-and-science/cpr.isp or through the Alabama Department of Public Health at 334-206-2066.

Copyright Alabama State Nurses' Association Mar-May 2004
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