Healthcare Maintenance for Diabetic Patients
Every ...
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Description

Healthcare Maintenance for Diabetic Patients

Every visit: 

 • Review blood sugar log → goal AM fasting blood glucose 80-130

 • Blood pressure → goal SBP <140; ACEi/ARB first line

 • Weight, BMI → weight center referral if BMI > 40 or > 35 with poor control; nutrition referral for all patients

 • Foot exam (inspect skin, joints, pulses, sensation) esp if known neuropathy or PVD; ABIs/vascular referral if PVD

 • Smoking cessation counseling (Advise, Assist, Arrange)

Q3-6mo:

 • A1c Q6 months if controlled; Q3-6 months if A1c above target

Annually:

 • Lipids: moderate-intensity statin if 40-75 yrs old w/ ASCVD<7.5%; high-intensity statin if ASCVD>7.5%; ASA for 2°

prevention of CVD (limited evidence for 1° prevention)

 • Urine mAlb/Cr, BMP → consider ACEi/ARB if hypertensive w/ either proteinuria or GFR<60; refer to renal if GFR<30

 • Monofilament exam → if fail to feel at 4/10 specific sites, + for neuropathy (see PCOI for specific sites)

 • Retinopathy screen w/ dilated eye exam or retinal photography; can consider Q2-3yr if normal exam(s)

 • LFTs → consider elastography and/or hepatology referral if elevated to evaluate for NASH

Vaccines

 • Influenza annually

 • Hepatitis B series if age <60 and not immune

 • PPSV23 x1 age <65; re-dose x1 >65 with at least 5 years between doses



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MGH White Book Manual
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Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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