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Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Tuesday, September 27, 2016

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

Last updated: September 2015
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Component Care / Test / Screening Frequency / Which Patients
(“At diagnosis”=when diabetes is diagnosed)
General Recommendations for Care Perform diabetes-focused visit Every 3-6 months
Review care plan: assess goals/strengths/barriers Each visit, revise as needed
Assess nutrition, physical activity, BMI, and growth in youth Each visit
Aspirin or Other Antiplatelet Therapy Aspirin therapy 75-162 mg/day (unless contraindicated) Prescribe if known CVD
Consider if 10-year CVD risk >10%
Clinical judgment if 10-year CVD risk 5-10%
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
Blood Pressure Check blood pressure
Adult goal: <140/<90 mmHg
Youth goal: Varies with age
Each visit
Eye Care Retinal imaging or dilated eye exam by 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 visit; stress daily self-exam
Perform comprehensive lower extremity/foot exam At diagnosis, then annually
Screen for PAD (consider ABI) At diagnosis, then annually
Glycemic Control Check A1C, set/review individualized goal Every 3-6 months
Review medications, ask about hypoglycemia Each visit
If prescribed, review SMBG data Each visit
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
Kidney Care Check UACR At diagnosis, then annually
Check serum creatinine and estimated GFR At diagnosis, then annually
If HTN/CKD, prescribe ACE Inhibitor or ARB unless contraindicated  
Lipid Management Check lipid profile
At diagnosis, then annually as needed
Lifestyle therapy
All patients with diabetes
Statin therapy Patients with diabetes 40-75 years of age and those with CVD regardless of age
Nutrition Provide nutrition education and support
Refer to RD for MNT, if available
At diagnosis, then annually or more as needed
Oral Care Inspection of gums/teeth At diagnosis, then each visit
Dental exam by dental professional At diagnosis, then every 6-12 months
Preconception, Pregnancy, and Postpartum Care Ask about reproductive intentions/assess contraception At diagnosis, then each 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 years lifelong
Self-Management Education Refer to diabetes educator At diagnosis, then every 6-12 months or more as needed
Tobacco Use Assess smoking, e-cigarette, oral tobacco use Each visit: Ask, Advise, Assess, Assist, Arrange
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Division of Diabetes Treatment and Prevention | Phone: 1-844-IHS-DDTP (1-844-447-3387) | diabetesprogram@ihs.gov