Diabetes mellitus is a chronic illness that requires continuing medical care and ongoing patient self-management, education, and support to prevent acute complications and reduce the risk of long-term complications. Diabetes care is complex and requires that providers address many issues beyond glycemic control. A large body of evidence supports a range of interventions to improve diabetes outcomes.
These standards of care are intended to provide clinicians, patients, researchers, payers, and other interested individuals with the components of diabetes care, general treatment goals, and tools to evaluate quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets desirable for most diabetes patients are included.
The updated recommendations are as follows:
- A1C: Frequency every 3-6 months based on individual therapeutic goal
- Urine microalbumin measurement (unless already on ACE or ARB)
- Lipid profile, preferably fasting
- Treatment of hypertension using up to 3-4 anti-hypertensive medications to achieve adult target of < 140/90 mmHg (see MQIC hypertension guideline). Mortality increases if diastolic is < 70.
- Prescription of ACE inhibitor or angiotensin receptor blocker in patients with chronic kidney disease or albuminuria*
- Moderate intensity statin therapy for primary prevention against macrovascular complications (e.g. simvastatin 20-40 mg, atorvastatin 10-20 mg)
- For patients with overt CVD, high intensity statin (e.g. atorvastatin 40-80 mg)
*Consider referral of patients with serum creatinine value >2.0 mg/dl (adult value) or persistent albuminuria to nephrologist for evaluation.