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2.      Each Clinic Visit        

 

Blood Pressure - Target BP is <130/<80.  Additional protection against complications, including renal failure and cardiovascular disease, may be obtained by lowering BP further.  
 

Weight - Compare with measurements from prior visits to identify trends.  
 

Blood Glucose - Results of lab determinations and self-monitoring should be available for timely discussion with the patient.  Hemoglobin A1c (A1C) is the "gold standard" for assessing glucose control.  This test should be conducted at least twice a year in each patient and ideally at 3-4 month intervals. Lowering A1C has been associated with a reduction in microvascular and neuropathic complications of diabetes.

l Fasting/post-prandial glucose measurement and self-monitoring records should be available for timely discussion with the patient at each visit. Self-monitoring BG records are vital to diabetes management decisions.
l Assess glycemic control by reviewing A1C results determined within the past 3-4 months.  Acceptable glycemic control is < 7.0%. A1C estimates the average degree of glycemic  control over the preceding 3 months. A1C is the standard way to measure glycemic control.
l HbA1c results should be discussed with the patient at the time of the patient visit. If in-house measurement is unavailable, blood sample should be obtained several days before the clinic visit.

At each clinic visit, the appropriate education, intervention, referral, and or follow-up will be provided as indicated.

 

Foot Inspection - Inspection of feet and nails. Check for ingrown toenails, calluses, deformities, pressure points, ulcers, and cellulitis.  A more comprehensive foot exam is recommended to be done annually (see section 3).

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