Diabetes management guidelines
Excerpt from “Standards of Medical Care in Diabetes—2010″ By American Diabetes Association
People with diabetes should receive medical care from a physician-coordinated team. Such teams may include, but are not limited to, physicians, nurse practitioners, physician’s assistants, nurses, dietitians, pharmacists, and mental health professionals with expertise and a special interest in diabetes. It is essential in this collaborative and integrated team approach that individuals with diabetes assume an active role in their care.
The management plan should be formulated as a collaborative therapeutic alliance among the patient and family, the physician, and other members of the health care team. A variety of strategies and techniques should be used to provide adequate education and development of problem-solving skills in the various aspects of diabetes management. Implementation of the management plan requires that each aspect is understood and agreed to by the patient and the care providers and that the goals and treatment plan are reasonable. Any plan should recognize diabetes self-management education (DSME) and on-going diabetes support as an integral component of care. In developing the plan, consideration should be given to the patient’s age, school or work schedule and conditions, physical activity, eating patterns, social situation and cultural factors, and presence of complications of diabetes or other medical conditions.
Glycemic control – Assessment of glycemic control
Two primary techniques are available for health providers and patients to assess the effectiveness of the management plan on glycemic control: patient self-monitoring of blood glucose (SMBG) or interstitial glucose and A1C.
a. Glucose monitoring
Recommendations
-
SMBG should be carried out three or more times daily for patients using multiple insulin injections or insulin pump therapy. (A)
-
For patients using less frequent insulin injections, noninsulin therapies, or medical nutrition therapy (MNT) alone, SMBG may be useful as a guide to the success of therapy. (E)
-
To achieve postprandial glucose targets, postprandial SMBG may be appropriate. (E)
-
When prescribing SMBG, ensure that patients receive initial instruction in, and routine follow-up evaluation of, SMBG technique and using data to adjust therapy. (E)
-
Continuous glucose monitoring (CGM) in conjunction with intensive insulin regimens can be a useful tool to lower A1C in selected adults (age ≥25 years) with type 1 diabetes (A).
-
Although the evidence for A1C lowering is less strong in children, teens, and younger adults, CGM may be helpful in these groups. Success correlates with adherence to ongoing use of the device. (C)
-
CGM may be a supplemental tool to SMBG in those with hypoglycemia unawareness and/or frequent hypoglycemic episodes. (E)
b. A1C
Recommendations
-
Perform the A1C test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control). (E)
-
Perform the A1C test quarterly in patients whose therapy has changed or who are not meeting glycemic goals. (E)
-
Use of point-of-care testing for A1C allows for timely decisions on therapy changes, when needed. (E)
