U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Wednesday, September 02, 2015

Division of Diabetes Treatment and Prevention - Leading the effort to treat and prevent diabetes in American Indians and Alaska Natives

Standards of Care and Clinical Practice
Recommendations: Type 2 Diabetes

Component Care / Test / Screening Frequency / Which Patients
(“At diagnosis”=when diabetes is diagnosed)

Adapted with permission from Wisconsin Diabetes Mellitus Essential Care Guidelines. (2011). Quick Reference: 2011 Wisconsin Diabetes Guidelines at a Glance (DHS Publication No. P-49356 Rev.03/2011). Madison, WI: Wisconsin Department of Health Services, Division of Public Health.

General Recommendations for Care Perform diabetes-focused visit Every 3-6 months
Review care plan: assess goals/strengths/barriers Each diabetes visit, revise as needed
Assess nutrition, physical activity, BMI, and growth in youth Each diabetes visit
Self-Management Education (DSME) Refer to diabetes educator At diagnosis, then every 6-12 mo., or more as needed
Medical Nutrition Therapy (MNT) Refer for MNT provided by a registered dietitian At diagnosis and at least yearly, or more as needed
Glycemic Control Check A1C, individualize goal: e.g., < 7%, 7-8%, 8-9%, etc. Every 3-6 months
Review goals, medications, side effects Every diabetes visit
If prescribed, review SMBG data Every diabetes visit
CVD Risk Reduction Prescribe statin with lifestyle therapy regardless of LDL level Adults with CVD; age > 40 y. with ≥ 1 CVD risk factor
Check lipid profile
LDL < 100 mg/dL (optimal goal), LDL < 70 mg/dL (for very high risk)
Non-HDL cholesterol < 130 mg/dL, < 100 mg/dL (for very high risk)
Annually. If abnormal, follow current NCEP guidelines.
Assess smoking/oral tobacco use Each visit: Ask, Advise, Assess, Assist, Arrange
Aspirin therapy 75-162 mg/day (unless contraindicated) Known CVD/PAD; 10-year CVD Risk > 10%
Blood Pressure Check blood pressure
Adult goal: <140/<90 mmHg
Youth goal: Varies with age
Every visit
Kidney Care Check urine albumin/creatinine ratio (UACR) for albuminuria using a random urine sample (normal < 30 mg/g; micro 30-300 mg/g; macro > 300 mg/g) At diagnosis, then annually
Check serum creatinine and estimate GFR
If HTN, prescribe ACE Inhibitor or ARB unless contraindicated
At diagnosis, then annually
Eye Care Retinal camera photo or dilated eye exam by an ophthalmologist or optometrist At diagnosis, then annually; or as directed by eye specialist
Foot Care Visual inspection of feet with shoes and socks off Each diabetes visit; stress daily self-exam
Perform comprehensive lower extremity/foot exam At diagnosis, then annually
Screen for PAD (consider ABI) At diagnosis, then annually
Oral Care Inspection of gums/teeth At diagnosis, then at diabetes visits
Dental exam by dental professional At diagnosis, then every 6-12 months
Autonomic Neuropathy Assess CV symptoms; resting tachycardia, exercise intolerance, orthostatic hypotension At diagnosis, then annually
Assess GI symptoms; gastroparesis, constipation, diarrhea At diagnosis, then annually
Assess sexual health/function for men and women At diagnosis, then annually
Behavioral Health Assess emotional health (e.g. depression, substance abuse) At diagnosis, then regularly
Immunizations Hepatitis B Unvaccinated adults <60 years of age; Consider for unvaccinated adults ≥60 years of age based upon patient's risk factors
Influenza vaccine Annually
Pneumococcal vaccines See Standard of Care
Tetanus and Diphtheria Provide every 10 years; tetanus, diphtheria, and acellular pertussis (Tdap) should replace a single dose of Td for anyone who has not previously received a dose of Tdap
Zoster vaccine Unvaccinated adults ≥60 years of age
Preconception, Pregnancy, and Postpartum Care Ask about reproductive intentions/assess contraception At diagnosis, and then every visit
Provide preconception counseling 3-4 months prior to conception
Screen for undiagnosed type 2 diabetes At first prenatal visit
Screen for GDM in all women not known to have diabetes At 24-28 weeks gestation
Screen for type 2 diabetes in women who had GDM At 6-12 weeks postpartum, then every 1-3 y. lifelong
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Division of Diabetes Treatment and Prevention | Phone: 1-844-IHS-DDTP (1-844-447-3387) | diabetesprogram@ihs.gov