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Diabetes and Cardiovascular Disease Provider Reference Guide (Prg)

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Diabetes and Cardiovascular Disease Provider Reference Guide (Prg) Diabetes and Cardiovascular Disease Provider Reference Guide (prg) DIABETES QUALITY IMPROVEMENT PROJECT CMA FOUNDATION . DIABETES AND CARDIOVASCULAR DISEASE PROVIDER REFERENCE GUIDE . JULY 2011 CMA FOUNDATION . DIABETES AND CARDIOVASCULAR DISEASE PROVIDER REFEREN2ndCE GUIDE ed .,. JULY 2011 2011 i Disclaimer & Terms of Use The Diabetes and Cardiovascular Disease Provider Reference Guide (PRG), 2011 (2nd ed.) is intended for physicians and health care professionals to utilize as a decision-making aid in the diagnosis, management and education of patients with type 2 diabetes. While the PRG describes recommended courses of intervention, it is not intended as a substitute for the advice of a physician or other knowledgeable health care professionals. We encourage all healthcare professionals to use their best clinical judgment as the recommendations may not be appropriate in all encounters. Any application of these recommendations should be made in consideration of the needs, conditions and circumstances of each individual patient. The PRG represents best clinical practices at the time of publication, with the recognition that guidelines and practice standards may change as more knowledge is gained. Unless otherwise stated, all material in the PRG may be reproduced with credit to the “CMA Foundation, Diabetes and Cardiovascular Disease Provider Reference Guide (PRG), 2011 (2nd ed.).” Diabetes Quality Improvement Project 3835 N Freeway Blvd Ste 100 Sacramento, CA 95658 Phone: (916) 779-6643 Fax: (916) 779-6658 www.thecmafoundation.org/projects/aped CMA FOUNDATION . DIABETES AND CARDIOVASCULAR DISEASE PROVIDER REFERENCE GUIDE . JULY 2011 CMA FOUNDATION . DIABETES AND CARDIOVASCULAR DISEASE PROVIDER REFERENCE GUIDE . JULY 2011 CALIFORNIA MEDICAL ASSOCIATION FOUNDATION DEAR COLLEAGUES, 3835 N. Freeway Blvd., Ste. 100 Sacramento, CA 95834 Despite our collective best efforts, the prevalence of diabetes continues to grow Tel: 916.779.6620 across the United States. According to latest estimates from the Centers for Disease Fax: 916.779.6658 Control and Prevention (CDC), diabetes now affects 26 million people in the 1 www.thecmafoundation.org United States. This means that over eight percent (8.3%) of Americans have diabetes. BOARD OF DIRECTORS Dexter Louie, MD Chair Over the past few years, there has been an increasing effort to educate healthcare Associate Medical Director Chinese Community Health Plan providers about the need to address the cardiovascular risks and complications David Holley, MD associated with diabetes. In fact, in April 2011, the American Association of Vice Chair Clinical Endocrinologists (AACE) issued clinical guidelines that call for Chairman NORCAL Mutual Insurance Company comprehensive management of the patient with diabetes to include consideration of 2 Francis J. Crosson, MD cardiovascular risk in addition to glycemic control. Secretary-Treasurer Senior Fellow The Kaiser Permanente Institute for This Diabetes and Cardiovascular Disease Provider Reference Guide (PRG), 2011 Health Policy nd (2 ed.) was developed with the goal of bringing to healthcare providers in a variety Raquel D. Arias, MD Associate Dean, Educational Affairs, of practice settings current clinical guidelines, best practices and patient self Special Projects Associate Professor, Obstetrics and management resources, all in one easy-to-use guide. Coordinated by the California Gynecology Medical Association (CMA) Foundation, 29 physicians and other healthcare Paul B. Carroll professionals contributed to the update of the PRG content. What has come of their Principal Devil’s Advocate Group efforts is a key resource that is evidence-based and contains the most effective ways Dustin Corcoran to prevent, assess and manage diabetes and its cardiovascular complications. Chief Executive Officer California Medical Association New for 2011: Lisa Folberg Vice President • Identification and management of prediabetes Medical and Regulatory Policy California Medical Association • An updated “Management” chapter that integrates blood glucose, hypertension Dev GnanaDev, MD, MBA, FACS and hyperlipidemia management all in one chapter (reflecting a more Immediate Past President comprehensive management of diabetes) California Medical Association James G. Hinsdale, MD • Adult outpatient insulin guidelines for type 2 diabetes, including a decision President-Elect matrix, from the Diabetes Coalition of California California Medical Association • Physical activity guidelines for type 2 diabetes Carol A. Lee, Esq. President and CEO • Tips to improve medication adherence CMA Foundation • Updated pharmacotherapy grids to treat and manage diabetes, hypertension Anmol S. Mahal, MD Medical Director and dyslipidemia Free Medical Clinic at • A Diabetes Care Guidelines & Flow Sheet that allows you to easily identify all India Community Center with the American Association of Physicians of recommended care for your patient compared to target goals – all on a single Indian Origin page J. Mario Molina, MD Chairman and CEO • Updated ICD-9-CM codes Molina Healthcare, Inc. Diana E. Ramos, MD, MPH Please join the efforts of the CMA Foundation as we work in collaboration with Medical Director Reproductive Health Programs physicians, healthcare providers, health plans and other stakeholders to advance the Los Angeles County Public Health Department practice of diabetes care and promote better patient self management and adherence. Austin A. Robinson You can find a web-based version of the PRG and additional practice and patient Medical Student resources by going to the CMA Foundation’s Diabetes Quality Improvement David Geffen School of Medicine at University of California Los Angeles Project’s website at www.thecmafoundation.org/projects/aped. For more Michael Steenburgh information about the CMA Foundation, please visit us at Executive Director San Joaquin Medical Society www.thecmafoundation.org Scott Syphax President and CEO Sincerely, Nehemiah Corporation of America Robert E. Wailes, MD Medical Director Pacific Pain Medicine Consultants Dexter Louie, MD Chair, CMA Foundation Board of Directors CMA FOUNDATION . DIABETES AND CARDIOVASCULAR DISEASE PROVIDER REFERENCE GUIDE . JULY 2011 CMA FOUNDATION . DIABETES AND CARDIOVASCULAR DISEASE PROVIDER REFERENCE GUIDE . JULY 2011 iii CMA FOUNDATION . DIABETES AND CARDIOVASCULAR DISEASE PROVIDER REFERENCE GUIDE . JULY 2011 CMA FOUNDATION . DIABETES AND CARDIOVASCULAR DISEASE PROVIDER REFERENCE GUIDE . JULY 2011 TABLE OF CONTENTS Preface - About the Diabetes and Cardiovascular Disease Provider Reference Guide (PRG) • Acknowledgements................................................................................................ x • Making and Using the PRG................................................................................... xi • Diabetes and Cardiovascular Disease Overview.................................................. xii 1 Prevention and Delay of Type 2 Diabetes • Prediabetes............................................................................................................ 4 • Obesity................................................................................................................... 5 • Metabolic Syndrome.............................................................................................. 8 2 Screening and Diagnosis of Type 2 Diabetes, Hypertension and Dyslipidemia • Signs and Symptoms of Type 2 Diabetes............................................................ 10 • Assessing Adult Risk for Diabetes and Cardiovascular Disease.......................... 10 -Contributing Risk Factors.................................................................................... 10 -American Diabetes Association (ADA) Risk Test................................................. 11 -Framingham Risk Score...................................................................................... 11 -Cardiovascular Disease Evaluation Considerations........................................... 12 • Screening and Diagnostic Testing........................................................................ 13 • Type 2 Diabetes Screening and Diagnostic Criteria............................................. 14 -Screening in Asymptomatic Adults..................................................................... 14 -Hypertension Screening and Diagnosis Criteria................................................. 15 -Dyslipidemia Screening and Diagnosis Criteria.................................................. 17 3 Comprehensive Management of Type 2 Diabetes • Diabetes Care Guidelines/Flowsheet................................................................... 20 • Achieving Glycemic Control................................................................................. 22 -A1c Recommendations...................................................................................... 22 -Blood Glucose Level Goals................................................................................ 23 -Monitoring Blood Glucose Levels....................................................................... 23 -Proper Disposal of Syringes and Needles.......................................................... 25 -Patient Logs and Worksheets............................................................................. 26 -Pharmacotherapy................................................................................................ 26 -Insulin Guidelines...............................................................................................
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