Type 2 Diabetes Adult Outpatient Insulin Guidelines - CMA Foundation

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Lifestyle Interventions and Modifications 36,37,38,39 Therapies focused on modification of patient lifestyle (Therapeutic Lifestyle Changes or TLC), including medical nutrition therapy (MNT) and exercise programs, are essential to achieving glycemic, lipid and blood pressure control, moderate weight loss and reduction of cardiovascular risk factors. Tips for Supporting Lifestyle Change • Encourage lifestyle modifications that reduce total caloric intake, saturated and trans fat consumption and cholesterol and sodium intake such as: o Consume carbohydrates from fruits, vegetables whole grains, legumes and low-fat milk o Monitor carbohydrate intake o Consume a variety of fiber-rich foods like beans, berries and greens o Limit sodium intake • Encourage moderate to vigorous physical activity to improve glucose, lipid and blood pressure values • Refer patients to registered dietician and/or to Medical Nutrition Therapy for additional support • Encourage patients to quit smoking TABLe 25 Recommended Lifestyle Modifications Target Therapy Goal Recommendations Overweight and obesity Healthy weight and BMI Advise weight reduction to optimize BMI ≥18.5 and
Weight Loss/Maintenance Even a moderate loss of 5-10% of overall body weight in patients with diabetes will result in improvement of blood glucose, blood pressure and lipids profile. Nearly 80% of patients who lose weight will gradually regain it if they are not supported by a weight maintenance program. The keys to a successful weight maintenance program are patient motivation and team support from health care providers. Effective management of overweight and obesity can be delivered by a variety of healthcare providers including primary care providers, registered dietitians, nutritionists, exercise physiologists, nurses, and psychologists. Achieving and maintaining an appropriate body weight requires daily effort, good dietary/ nutritional behaviors and adequate physical activity. Combined management approaches (diet, exercise and behavior modification) are likely to produce better results than any single approach. Healthcare providers should encourage patients to consult their health plan for weight loss/ maintenance programs that may be covered by their policy. Medical Nutrition Therapy (MNT) 9,36,40,41 Medical Nutrition Therapy (MNT) services involve a nutritional assessment, specific diet planning, and counseling services to prevent or treat an illness or medical condition. MNT counseling services are typically provided by a registered dietitian (RD) focusing on behavior and lifestyle changes with the goal of addressing nutrition problems and associated medical conditions, such as diabetes. MNT goals for the treatment of diabetes focus on interventions to maintain blood glucose, lipids, and blood pressure within a normal range in order to prevent or slow the rate of development of the chronic complications of the disease. In addition, MNT can be useful in helping patients with diabetes to achieve and maintain a healthy body weight. During each counseling session, the RD works with patients to assess individual needs, determine goals, develop a care plan, and monitor overall progress towards treatment goals. Coverage for and access to MNT services vary by health insurance program or carrier. Patients should consult with their health insurance evidence of coverage booklet or call their health plan regarding coverage for MNT services. Medicare currently covers MNT services for people with diabetes or renal disease as a means of helping to manage the condition covering. Medicare covers 3 hours of one-on-one counseling the first year, and 2 hours each subsequent year. Beneficiaries may be able to receive more hours of treatment with a physician’s referral if the condition, course of treatment or diagnosis changes. Physicians must prescribe MNT services for Medicare recipients and renew the referral annually as necessary. 41 For a list of CPT codes for MNT, please go to chapter 7, page 139. <strong>CMA</strong> FoundAtion . diAbetes And CArdiovAsCulAr diseAse Provider reFerenCe guide . july 2011 57 Comprehensive management of type 2 diabetes
Page 1 and 2: 3 Comprehensive Management of Type
Page 3 and 4: TAbLe 13 Diabetes Care Guidelines/F
Page 5 and 6: TAbLe 15 Recommended blood Glucose
Page 7 and 8: Proper Disposal of Syringes and Nee
Page 9 and 10: TAbLe 17 Oral Medications Drug clas
Page 11 and 12: TABLe 18 Non-Insulin Injectables Dr
Page 13 and 14: Diabetes Coalition of California Ty
Page 15 and 16: CMA FoundAtion . diAbetes And CArdi
Page 17 and 18: TABLe 20 Insulin Injectables Drug c
Page 19 and 20: separate prescriptions or in fixed-
Page 21 and 22: TABLe 22 Oral Blood Pressure Loweri
Page 23 and 24: TABLe 22 Oral Blood Pressure Loweri
Page 25 and 26: Reference Card From the Seventh Rep
Page 27 and 28: Clinical Management of Dyslipidemia
Page 29 and 30: Pharmacotherapy for Dyslipidemia 23
Page 31 and 32: TABLe 24 Lipid combinations Fibric
Page 33 and 34: 4 Step 4 5 Step 5 6 Step 6 If 2+ ri
Page 35 and 36: 8 Step 8 Identify metabolic syndrom
Page 37: Hard Coronary Heart Disease (10-Yea

Type 2 Diabetes Adult Outpatient Insulin Guidelines - CMA Foundation

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