DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
N. Follow-Up 77
MODULE E– EYE CARE 88
A. Has Patient’s Vision Changed Recently 90
B. Refer patients with Type 1 DM for Initial Eye Retinal Examination 90
C. Refer Patient with Type2 DM for Initial Eye Retinal Examination 91
D. Follow-Up Examination Yearly Or According To Eye Care Provider-Recommended Schedule 92
MODULE F – FOOT CARE 94
A. Perform and Document Visual Inspection of Feet 97
B. Perform Foot Risk Assessment 97
C. Are Any Limb-Threatening Conditions Present? 98
D. Refer to Appropriate Level of Care for Evaluation and Treatment 99
E. Is Patient at High-Risk for a Foot Problem? 100
F. Is There A Minor Wound Or Lesion? 101
G. Refer To Foot Care Specialist for Complete Evaluation and Treatment 101
H. Perform and Document Patient Education for Preventive Foot Care and Footwear 102
I. Perform Visual Inspection and Peripheral Sensation Evaluation At Each Routine Visit 103
J. Perform Wound Assessment 103
K. Provide Local Wound Care; Offload Pressure and Weight, As Indicated 104
L. Has Wound Healed Within 4 Weeks? 104
M. Is This A Minor Foot Problem? 105
N. Treat As Appropriate 105
MODULE M – SELF-MANAGEMENT AND EDUCATION 106
A. Is This a Patient With Newly Diagnosed Diabetes Mellitus? 108
B. Provide Information and Education on Basic Concepts and Core Competencies, Document Findings 108
C. Refer for Comprehensive Diabetes Self-Management and Diet Education 108
D. Determine Patient’s Extent of Knowledge and Self-Management Skill Deficit 111
E. Does the Patient Need Referral for Further Education or Intervention? 111
F. Refer as Appropriate for Comprehensive Self-Management and Diet Education or Risk-Focused
Intervention, or to a Case Manager or Appropriate Specialist 112
G. Reassess and Follow-Up as Indicated 113
H. Does The Patient Want More Information? 113
I. Provide Materials Or Patient Reference List Or Refer As Needed 114
J. Methods for Providing DSME 114
APPENDICES 121
Table of Contents Page 9