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

Version 4.0
RECOMMENDATIONS
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
1. Treatment goals should be periodically reassessed based upon patient specific factors, including changes in
the patient’s health status, adverse drug reactions, adherence to therapy, and preferences.
DISCUSSION
Treatment goals should be periodically reassessed based upon patient specific factors, including changes in the
patient’s health status, adverse drug reactions, adherence to therapy, and preferences.
Relative indications for raising the target glycemic goal include inability or unwillingness to adhere to a more
intensive regimen, or an unacceptable risk of hypoglycemia relative to anticipated benefits of near-normal glycemia.
If the target range remains appropriate but has not been reached, the provider and patient should identify the reasons
why the target has not been achieved and take appropriate action.
Reasons to consider lowering the target glycemic control goal include removal of barriers to improved control (e.g.,
substance abuse, intercurrent illnesses, and adherence issues) and resolution of relative contraindications (see
Annotation D).
N. Follow-Up
OBJECTIVE
Maintain glycemic control and ensure proper patient monitoring by the healthcare team.
RECOMMENDATIONS
1. Patients should be scheduled for appropriate follow-up to evaluate response, tolerability to therapy, goal reassessment,
and management of acute and chronic problems:
• The frequency of follow-up visits for the patient with diabetes who is meeting treatment goals and who
has no unstable chronic complications should be individualized
• When there is a sudden change in health status or when changes are made to the treatment regimen,
follow-up within one month or sooner may be appropriate.
2. Treatment goals should be periodically reassessed based upon patient-specific factors, including changes in
the patient’s health status, adverse drug reactions, adherence to therapy, and preferences.
Module G: Glycemic Control Page 77