Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

HIV/AIDS

Quick Links

Veterans Crisis Line Badge
My healthevet badge

Monitoring and Other Diabetes Prevention Strategies

for Health Care Providers

Monitoring and Other Prevention Strategies

Back to Diabetes Chapter

MethodGoalComments
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
  • 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