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

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Version 4.0 MODULE D – CORE ANNOTATIONS VA/DoD Clinical Practice Guideline for the Management of Diabetes Mellitus The core module provides an overview of the important components of diabetes care that should be considered at each visit and the interventions that should be performed at appropriate intervals. This module will assist the provider to organize and prioritize a care plan for persons with diabetes mellitus (DM). A. Patient with Diabetes Mellitus Diabetes mellitus (DM) is a state of absolute or relative insulin deficiency resulting in hyperglycemia. This algorithm applies to adults only (age ≥17), both diabetes type 1 and type 2 (formerly referred to as insulin-dependent and non-insulin dependent diabetes mellitus), but not to gestational diabetes mellitus (GDM). Diagnosis of Diabetes The criteria for the diagnosis of DM include any of the following: a. Fasting plasma glucose (FPG) is ≥126 mg/dL on at least two occasions; or, b. A single HbA 1 c reading of ≥ 6.5% confirmed with a FPG ≥126 mg/dL. These tests can be done on the same or different days; or, c. HbA 1 c reading of ≥ 7% on two occasions using a clinical laboratory methodology standardized to the National Glycohemoglobin Standardization Program (NGSP) not a Point of Care; or , d. Patient with symptoms of hyperglycemia, and a random glucose is ≥ 200 mg/dL on two occasions. However, random plasma glucose is not recommended as a routine screening test. Oral glucose tolerance testing (OGTT) is no longer recommended in clinical practice. An individual with a casual plasma glucose level ≥200 mg/dL, but without symptoms, should have his or her fasting blood glucose measured. The diagnostic criteria for diabetes are summarized in table D1. (See Module S: Screening for DM) Diagnosis of Prediabetes Hyperglycemia not sufficient to meet the diagnostic criteria for diabetes has historically been categorized as either impaired fasting glucose (IFG), or impaired glucose tolerance (IGT) depending on the methodology through which it is identified. The criteria for diagnosis of prediabetes include any of the following: a. Fasting plasma glucose (FPG) readings with result < 126 mg/dL, but ≥100mg/dL on two occasions. b. HbA 1 c readings with result ≥5.7%, with FPG ≥100 mg/dL and
Version 4.0 Table D1. Diagnosis of Diabetes Mellitus Status Fasting Plasma Glucose (FPG) or, Hemoglobin A 1 c (c) Diabetes Mellitus (a) (b) FPG >126 mg/dL (7.0 mmol/L) on two occasions OR HbA 1 c is ≥ 6.5% and FPG >126 mg/dL (7.0 mmol/L) OR HbA 1 c ≥7% on two occasions VA/DoD Clinical Practice Guideline for the Management of Diabetes Mellitus Casual Plasma Glucose (d) Casual plasma glucose ≥200 mg/dL (11.1 mmol/L) plus symptoms of diabetes Pre-diabetes FPG ≥100 and 5.7% and FPG ≥100 and
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