Mount Carmel Health Partners Clinical Guidelines Diabetes Type II

Diabetes Type 2 Clinical Guideline
Definition: Diabetes is a multifactorial metabolic disease that is influenced by environmental and genetic factors characterized
by impairment of insulin secretion from pancreatic B-cells and insulin resistance in peripheral tissues.
Causes: Diabetes Type 2 is due mostly to lifestyle factors and genetics.
Screening Recommendations
Population
Method
Quick Guide to Diabetes Care
Diagnostic criteria:
Frequency
Patients age 45 and older If normal, every 3 years at
FPG or two-hour OGTT,
minimum, annually if
HbA1c
prediabetes.
Adults any age with BMI
greater than 25 AND one or
more risk factors. If normal, every 3 years at
FPG or two-hour OGTT,
minimum, annually if
HbA1c
prediabetes.
Overweight children (BMI
greater than 85th percentile)
with ANY 2 risk factors
No
FPG preferred for
children
Initiate screening at age 10
or at onset of puberty,
whichever comes first. If
normal, every 3 years at
minimum
•HbA1c ≥ 6.5%
•2 random blood glucose ≥ 200 mg/dL
•Fasting plasma glucose ≥ 126 mg/dL
 2-hr plasma glucose ≥ 200 mg/dl
after OGTT
Yes




HbA1c greater than or equal to 6.5%
Fasting glucose greater than or equal to 126 mg/dL
2-hr oral glucose tolerance test greater than or
equal to 200 mg/dL.
2 random plasma glucose ≥200 (or 1 random
plasma glucose ≥200 + signs/symptoms of
hyperglycemia)
Goals and Monitoring:
 A reasonable treatment goal for most
non-pregnant adults is HbA1c < 7.0%¹
 HbA1c should be monitored at least twice yearly in
those patients who are meeting treatment goals.
 HbA1c should be monitored quarterly if the patient
is not meeting treatment goals.
 Lifestyle modification should be encouraged:
regular exercise, diet, and smoking cessation.
 Recommend annual influenza vaccine,
pneumococcal vaccine as appropriate, and
hepatitis B vaccine (series).
Initiate management with lifestyle
modifications; consider referral for
diabetes education and/or medical
nutrition therapy
Is patient meeting
treatment goals after 3
months of management?
Monitor HbA1c quarterly
and manage medications
(see Table 1)
Yes
No
For refractory patients, consider
referral to endocrinologist
Follow-up and monitor at
least every 3 years
Monitor HbA1c twice yearly (flu,
Pneumococcal and hepatitis B vaccines as
appropriate
¹ Less stringent treatment goals may be appropriate for patients with a history of severe hypoglycemia, patients with limited life expectancies, very young
children or older adults, and individuals with comorbid conditions. More stringent goals may be appropriate for certain populations.
May 2017