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

Version 4.0
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
I. Review All Diabetes-Related Complications and Set Priorities
OBJECTIVE
Identify DM-related complications requiring special attention.
RECOMMENDATIONS
1. If the individualized HbA 1 c is not on target, refer to Module G – Glycemic Control
2. Measure blood pressure on every diabetes visit. If systolic blood pressure (SBP) >140 mmHg or diastolic
blood pressure (DBP) is >90 mmHg, refer to the VA/DoD Clinical Practice Guideline for the Management
of Hypertension. (Also see Annotation J)
3. Measure fasting lipids (TC, HDL-C, TG and calculated LDL-C) if not done within one year. If the patient
has elevated cholesterol or lipids, refer to the VA/DoD Clinical Practice Guideline for the Management of
Dyslipidemia (Lipids). (Also see Annotation K)
4. Screen for proteinuria and assess kidney function if not done within one year. If the patient develops microor
macroalbuminuria or decline in estimated glomerular filtration rate (eGFR), refer to the VA/DoD
Clinical Practice Guideline for the Management of Chronic Kidney Disease (CKD). (Also see
Annotation L)
5. Screen for retinopathy if not done within two years. If the patient has symptoms, or a previous exam
showed a high-risk for visual loss or retinopathy, refer to Module E – Eye Care.
6. Complete a foot-risk assessment if not done within one year. If the patient has risk factors or an active
lesion, refer to Module F – Foot Care.
7. If the patient needs additional nutritional or lifestyle education, refer to Module M – Self-Management
and Education.
8. If the patient is a candidate for an influenza vaccine, administer it in season. (See CDC recommendations)
9. Administer pneumococcal pneumonia vaccine, if indicated. (See CDC recommendations)
10. If the patient is using tobacco, refer to the VA/DoD Clinical Practice Guideline for the Management of
Tobacco Use Cessation.
Module D: Core Page 23