Mount Carmel Health Partners Clinical Guidelines Diabetes Type II

Diabetes Type 2 Clinical Guideline Definition: Diabetes is a multifactorial metabolic disease that is influenced by environmental and genetic factors characterized by impairment of insulin secretion from pancreatic B-cells and insulin resistance in peripheral tissues. Causes: Diabetes Type 2 is due mostly to lifestyle factors and genetics. Screening Recommendations Population Method Quick Guide to Diabetes Care Diagnostic criteria: Frequency Patients age 45 and older If normal, every 3 years at FPG or two-hour OGTT, minimum, annually if HbA1c prediabetes. Adults any age with BMI greater than 25 AND one or more risk factors. If normal, every 3 years at FPG or two-hour OGTT, minimum, annually if HbA1c prediabetes. Overweight children (BMI greater than 85th percentile) with ANY 2 risk factors No FPG preferred for children Initiate screening at age 10 or at onset of puberty, whichever comes first. If normal, every 3 years at minimum •HbA1c ≥ 6.5% •2 random blood glucose ≥ 200 mg/dL •Fasting plasma glucose ≥ 126 mg/dL  2-hr plasma glucose ≥ 200 mg/dl after OGTT Yes     HbA1c greater than or equal to 6.5% Fasting glucose greater than or equal to 126 mg/dL 2-hr oral glucose tolerance test greater than or equal to 200 mg/dL. 2 random plasma glucose ≥200 (or 1 random plasma glucose ≥200 + signs/symptoms of hyperglycemia) Goals and Monitoring:  A reasonable treatment goal for most non-pregnant adults is HbA1c < 7.0%¹  HbA1c should be monitored at least twice yearly in those patients who are meeting treatment goals.  HbA1c should be monitored quarterly if the patient is not meeting treatment goals.  Lifestyle modification should be encouraged: regular exercise, diet, and smoking cessation.  Recommend annual influenza vaccine, pneumococcal vaccine as appropriate, and hepatitis B vaccine (series). Initiate management with lifestyle modifications; consider referral for diabetes education and/or medical nutrition therapy Is patient meeting treatment goals after 3 months of management? Monitor HbA1c quarterly and manage medications (see Table 1) Yes No For refractory patients, consider referral to endocrinologist Follow-up and monitor at least every 3 years Monitor HbA1c twice yearly (flu, Pneumococcal and hepatitis B vaccines as appropriate ¹ Less stringent treatment goals may be appropriate for patients with a history of severe hypoglycemia, patients with limited life expectancies, very young children or older adults, and individuals with comorbid conditions. More stringent goals may be appropriate for certain populations. May 2017