| HbA1c | - <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
|
| SMBG | - 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
|
| LFTs | - 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
| |
| Pneumococcus vaccine | - Decreased risk of infection
| |
| Counseling on diet, weight loss, and exercise | - Improved glycemic control
| - On diagnosis and at every visit
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