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Monitoring and Other Diabetes Prevention Strategies

for Health Care Providers

Monitoring and Other Prevention Strategies

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  • <7%; less-stringent control may be appropriate for patients with advanced microvascular disease, comorbidities, or short life expectancy
  • Every 3 months if not at goal or after change of medication or dosage
  • Every 6 months if at goal
  • Postprandial goal: <180 mg/dL (for type 2 diabetes)
  • Fasting goal: 90-130 mg/dL
  • Patients on insulin: measure 3 times daily before meals until glucose is controlled; then measure once daily alternating prebreakfast, lunch, supper, and bedtime
  • Midnight SMBG may be helpful to detect hypoglycemia if FBG is persistently elevated (from the dawn phenomenon [Somogyi effect])
  • Patients not on insulin: if unstable or in poor glycemic control, measure fasting glucose several times per week, or on specified timeline; if controlled, measure 2 times/week
  • Patients should be educated regarding symptoms of hypoglycemia (eg, sweating, anxiety, disorientation, tachycardia) and instructed to ingest hard candy, juice, or other rapidly absorbed glucose source if symptoms occur
  • Note: SMBG has no benefit if not used to guide therapy
Blood pressure
  • SBP: <140 mmHg
  • DBP: <80 mmHg
Fasting lipids
  • LDL: <100 mg/dL (<70 mg/dL with CV disease)
  • HDL: >40 mg/dL
  • TG: <150 mg/dL
  • Every 3-6 months if adjusting medications
  • Annually if stable and at goal
  • Use statins or other lipid-lowering agents as indicated
  • Be aware of possible interactions between PIs and statins (see Dyslipidemia and Lipid-Lowering Medications)
  • With most PIs, rosuvastatin or pravastatin is preferred; alternatively, low dosage of atorvastatin
  • May need to increase dosage when using statins with NNRTIs
  • ALT <2.5 times upper limit of normal
  • Monitor every 6 months in patients on sulfonylureas or statins
Urine albumin/Cr ratio
  • Slow progression of renal injury
  • Albumin/Cr ratio ≤30 mg/g
  • Microalbuminuria: urine albumin/Cr ratio >30 mg/g; confirmed with 2 out of 3 urine tests. Treat albuminuria with ACE inhibitor or ARB (see Renal Disease)
Foot examination
  • Prevention of ulcers, infections
  • Detection of neuropathy
  • Early intervention
  • Perform foot risk assessment annually (see Initial Evaluation, above)
  • Educate patient about preventive foot care
  • Refer to Podiatry as needed for lesions and protective footwear
  • Refer to Vascular Surgery for evaluation of arterial insufficiency
Retinal eye examination
  • Vision maintenance; early diagnosis of retinopathy
  • Annually, by an ophthalmologist
  • Laser therapy available for diabetic retinopathy
Influenza vaccine
  • Decreased risk of infection
  • Annually
Pneumococcus vaccine
  • Decreased risk of infection
  • Every 5 years
Counseling on diet, weight loss, and exercise
  • Improved glycemic control
  • On diagnosis and at every visit

From Diabetes
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009