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Diabetes Standards of Care and Resources for Clinicians and Educators

Recommendations At-a-Glance

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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, or at increased risk of bleeding) Prescribe if known ASCVD
Consider in patients aged 50-70 with no known ASCVD but with 1 or more risk factors for ASCVD
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 annually
Blood Pressure Check blood pressure
Adult and Adolescents aged ≥ 13 years goal: <130/<80 mmHg
Children aged < 13 years goal: varies with age
Each visit
DSME/S Clinical provider and/or diabetes educator provides individualized DSME/S At diagnosis, then annually or more as needed
Eye Care Comprehensive dilated eye exam by an eye care professional or retinal imaging At diagnosis, then annually or as directed by an eye care professional
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
Address medication adherence, hypoglycemia Each visit
Review BGM and/or CGM results, if prescribed Each visit
Hepatitis C Screening Screen for hepatitis C with a hepatitis C antibody test At least once for persons ≥ 18 years
Immunizations Hepatitis B Administer to unvaccinated adults aged 18 to 59; consider for unvaccinated adults ≥ 60 years based on infection risk
Influenza Administer annually to everyone ≥ 6 months of age
Pneumococcus Administer pneumococcal conjugate vaccine (PCV20 or PCV15) to unvaccinated adults with diabetes aged 19 years of age and older. (If PCV15 is given, administer a dose of pneumococcal polysaccharide vaccine (PPSV23) ≥1 year later.)

[See Immunization Standard of Care for recommendations for adults who have previously received any pneumococcal vaccine.]
Tetanus, diphtheria, and acellular pertussis (Tdap) or tetanus and diphtheria (Td) Administer Tdap at least once to anyone who has not previously received Tdap. Provide booster Tdap or Td every 10 years
Shingles (Herpes zoster) Administer Shingrix two-dose vaccine to adults ≥ 50 years
Kidney Care Check quantitative UACR At diagnosis, then at least annually
Check serum creatinine and estimated GFR At diagnosis, then at least annually
If HTN/CKD, prescribe ACE Inhibitor or ARB unless contraindicated  
Lipid Management Check fasting lipid profile At diagnosis, then annually, as needed
Lifestyle therapy All patients with diabetes
Statin therapy Patients with diabetes aged 40-75 years and those with ASCVD regardless of age
Nutrition Provide basic nutrition education (health care team) At diagnosis, then annually, or more as needed
Refer to an RD for individualized MNT, when available At diagnosis, then annually, or more as needed
Oral Care Inspection of gums/teeth At diagnosis, then at least annually
Dental exam by dental professional At diagnosis, then at least annually
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
Tobacco Use Assess smoking, oral tobacco use, e-cigarette use, and exposure to secondhand smoke Screen annually
For tobacco users, provide cessation counseling Each visit
Tuberculosis Screening Screen for TB with a skin or blood test At least once after diabetes diagnosis