| Components of Care Visits for Adults with Type 2 Diabetes | |
| Vitals |
q Weight q Re-calculate BMI q Measure height if not on chart q Compare with previous weights and BMI to monitor trends |
| Blood Pressure Assessment |
q Assess at every visit q Monitor and adjust therapy to keep BP < 130/80 mmHg |
|
Glycemic Control Assessment |
q A1c if indicated. Goal: <7% (e.g., <6.5%, can be considered for some patients) q Review log of patient’s Self Blood Glucose Monitor (SBGM) results q Point-of-care capillary blood glucose check if indicated q
Monitor and adjust therapy to attain glycemic goals |
| Chronic Kidney Disease Assessment
q Annual for screening q More frequently for monitoring of CKD |
q Estimated GFR: q Serum creatinine (needed for calculation of GFR) q Albumin to Creatinine Ratio (UACR) [review diagnosis] q Preserve kidney function: q Consider ACE inhibitor or ARB q Lower targets for BP control: <120/70 mmHg q If GFR < 60: q Hemoglobin/Hematocrit for presence of anemia q
Ca, PO4, and PTH to assess metabolic bone disease |
| Lipids Assessment |
At least
annually, more frequently if monitoring therapy: q
Fasting lipoprotein panel (Total cholesterol, LDL, HDL, and
triglyceride) q
If fasting lipids
not possible/reasonable, consider direct LDL, total cholesterol and HDL q
Additional lipid testing may be needed to adjust
pharmacologic therapy |
| Antiplatelet Therapy | q
Aspirin or other
antiplatelet agent prescribed in appropriate clinical setting |
| Visit Exams |
q Directed exam according to review of systems q Routine Foot Check q
Annual comprehensive neurovascular foot exam to include 10 g
monofilament exam |
| Immunization Status Review |
q Influenza immunization annually, q PneumoVax at diagnosis. Re-immunization if age 65 or older and first dose was given before age 65 q Tetanus and diphtheria every 10 years q HBV immunization if kidney status is compromised and GFR < 60 or at high risk for HBV |