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Version 4.0 VA/DoD Clinical Practice Guideline for the Management of Diabetes Mellitus MODULE G - GLYCEMIC CONTROL Module G: Glycemic Control Page 39
Version 4.0 VA/DoD Clinical Practice Guideline for the Management of Diabetes Mellitus MANAGEMENT OF DIABETES MELLITUS Module G - Glycemic Control G1 1 Patient with diabetes mellitus (DM) [A] 2 Assess glycemic control [B] 3 Determine glycemic control target by: I . Determine recommended target using risk stratification criteria, [C] and II. Adjust the glycemic target according to patient factors, [D] and III. Set a target range after discussion with patient [E] 4 Is patient high-risk? [F] Y 5 Consider referral for comprehensive evaluation and treatment of DM N 6 Is patient on medication therapy? Y N 7 Does patient require insulin? [G] Y 8 Institute/adjust insulin Consider referral [H] 9 N Assure appropriate intervention to address patient adherence [I] 10 Initiate/adjust therapy [R efer to Table G2 ] [J] Sequential treatment for type 2 DM 11 Reinforce self management education Consider referral for diet and DM education See Module M 1 Life Style modification, diet and excercise 2 Monotherapy with oral agent or insulin 3 Combination (add second oral agent) 4 Insulin with daytime oral agent 5. Insulin alone 6. Referral Continue DM management Return to Module D Continue on page G2 Jan-03 Module G: Glycemic Control Page 40
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