Full Clinical Guidelines - Community First Health Plans.

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Considerations for Prescribing Physical Activity for Type 2 Diabetes Prevention and Treatment Significant health benefits can be obtained by including an accumulated 30 minutes of moderate physical activity on most, if not all, days of the week. Regular physical activity lowers the risk of developing Type 2 diabetes. 1996 Surgeon General’s Report on Physical Activity and <strong>Health</strong> “Regular physical activity” includes all movements in everyday life, including work, recreation, exercise, and sporting activities. Low Intensity/Low Impact Activity - includes activities like walking, housework, light gardening, light yard work, and social dancing Moderate Intensity Activity - includes activities like brisk walking, vigorous gardening, slow cycling, aerobic dancing, doubles tennis, or hard work around the house. . Precautions for Exercise Prescription Retinopathy Patients with proliferative diabetic retinopathy have abnormal hemodynamic responses of the cerebral and ophthalmic circulation both at rest and with exercise. Vigorous physical activity, especially isometric contractions, produces significant increases in blood pressure and can accelerate proliferative diabetic retinopathy with significant risk of retinal and vitreal hemorrhage and detachment. Low impact/low intensity physical activity recommended. Orthopedic Problems Neuropathy and peripheral vascular disease can predict unnoticed foot injury. Footwear that relieves forefoot plantar pressure by up to 50% has been shown to be effective in preventing the recurrence of foot ulcers when worn for more than 60% of the day (Peirce, N. 1999. British Journal of Sports Medicine) <strong>Guidelines</strong> for Exercise Prescription 1. Appropriate attire for physical activity, i.e., footwear - socks, shoes, insoles/orthotics. 2. Do not exercise at peak hypoglycemic times. 3. Monitor blood glucose before and during exercise if symptoms of hypoglycemia occur with exercise. 4. Wear a form of personal identification or medical alert. 5. Carry fast acting carbohydrate, i.e., sucrose and glucose products. 6. Examine feet after exercise. 7. Maintain adequate hydration. 54 H EALTH PLANS www.cfhp.com
Hypertension Algorithm for Diabetes Mellitus in Adults Assess Blood Pressure 1 (BP) Follow-up BP each visit If microalbuminuria or nephropathy present (Table 1) BP 130/80 mmHg Start ACE inhibitor (ACEi) therapy 2-5 If microalbuminuria or nephropathy present (Table 1) If African-American- Start ACEi in combination with diuretic or CCB If SBP >145mmHg and/or DBP>90mmHg 6 Start with combination antihypertensive therapy Reassess therapy in 4-8 weeks-Titrate to at least ½ max dose Encourage self-monitoring of blood pressure 1 (on average > 3 medications will be needed to achieve blood pressure goals) Revised 1-26-06 Table1 Microalbuminuria/Proteinuria 3 • In Type 2 patients, an ACEi or angiotensin receptor blocker (ARB) may be used first line. • In Type 1 patients, an ACEi is recommended to reduce protein excretion • Consider the use of verapamil or diltiazem in patients with proteinuria unable to tolerate ACEi or ARBs. BP130/80 mmHg Continue Therapy BP Check Every Visit Add 6 Diuretic OR Calcium Channel Blocker (CCB) OR Beta Blocker If Diuretic Chosen: (Preferred if no other compelling indications) Creatinine 130/80 mmHg despite above agents or if intolerance/contraindications exist: Refer to Specialist (Endocrinologist or Nephrologist) OR ADD: α blocker, hydralazine, clonidine (caution with β blocker) 9.6 Hypertension Algorithm for DM in Adults H EALTH PLANS www.cfhp.com 55
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Community First Health Plans Qualit
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Page 45 and 46: GLYCEMIC CONTROL BIBLIOGRAPHY • R
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Risk Factors for Osteoporosis Fract
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It is well documented that obesity
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CLASSIFICATION OF OVERWEIGHT AND OB
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16.1.1 Preventive Pediatric Health
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TEXAS MEDICAID PROVIDER PROCEDURES
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CHILDREN’S SERVICES HANDBOOK P h
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CHILDREN’S SERVICES HANDBOOK P R
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FIGURE 2: Recommended immunization
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Comprehensive antepartum care is vi
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The following variables should be e
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CRITERIA 19. Unresolved Problems Fr
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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CFHP OB/GYN SPECIALTY MEDICAL RECOR
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According to the National Institute
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. aminotransferase (AST) and alanin
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PREVENTION RECOMMENDATIONS 1. The E
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2 to 20 years: Boys Body mass index
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AsthmaMatters is an initiative deve
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According to the Centers for Diseas
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