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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, including increased risk of bleeding) Prescribe if known CVD
Consider if no known CVD but at high risk
for CVD (e.g., age ≥ 50 and 1 or more risk factors for CVD)
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 goal: <140/<90 mmHg
Youth 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 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
Ask about medication adherence, hypoglycemia Each visit
Review SMBG results, if prescribed 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 basic nutrition education and support At diagnosis, then annually or more as needed
Refer to an RD for individualized MNT, if 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