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

Version 4.0
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
Table of Contents
INTRODUCTION 2
TABLE OF CONTENTS 8
MODULE D – CORE 10
A. Patient with Diabetes Mellitus 13
B. Refer To Pediatric Diabetes Management 15
C. Is Patient A Female of Reproductive Potential? 15
D. Identify Comorbid Conditions 16
E. Is the Patient Medically, Psychologically, and Socially Stable? 17
F. Identify/Update Related Problems from Medical Record, History, Physical Examination,
Laboratory Tests, and Nutritional and Educational Assessment 17
G. Determine and Document If Diabetes Mellitus Is Type 1 or 2 (If Not Already Done) 20
H. Consider Aspirin Therapy 21
I. Review All Diabetes-Related Complications and Set Priorities 23
J. Management of Hypertension in Diabetes Mellitus 24
K. Management of Dyslipidemia in Diabetes Mellitus 25
L. Management of Kidney Disease in Diabetes Mellitus 28
MODULE S - SCREENING FOR DIABETES 32
A. Screening for Diabetes Mellitus 34
B. Prevention of Diabetes 37
MODULE G - GLYCEMIC CONTROL 39
A. Patient with Diabetes Mellitus (DM) 42
B. Assess Glycemic Control 42
C. Determine Recommended Glycemic Control Target Using Risk Stratification Criteria 46
D. Adjust the Glycemic Target According To Patient Factors 49
E. Set a Glycemic Target Range after Discussion with the Patient 50
F. Is Patient High-Risk? 50
G. Does Patient Require Insulin? 51
H. Institute/Adjust Insulin; Consider Referral 51
I. Assure Appropriate Intervention to Address Patient Adherence 52
J. Initiate/Adjust Therapy 53
J-1. Monotherapy (Initial Therapy) 55
J-2. Combination Therapy (Add-On) 57
J-3. Insulin Therapy 61
J-4. Continuous Subcutaneous Insulin Infusion (Csii) 64
J-5. Glycemic Control for Hospitalized Patients 68
K. Determine If There Are Side Effects or Contraindications to Current Treatment 76
L. Are There Problems With Patient Adherence? 76
M. Should Glycemic Control Target Be Adjusted? 76
Table of Contents Page 8