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Patient Care Process for the Management of Diabetes



  • Patient characteristics (e.g., age, race, sex, pregnant)

  • Characteristics of diabetes (e.g., type, age of onset, initial presentation)

  • Microvascular and macrovascular complications

  • Hypoglycemia episodes, symptoms, frequency, and suspected cause(s)

  • History of diabetic ketoacidosis frequency, severity, and suspected cause

  • Patient history (past medical, family, social—dietary habits, weight history, sleep behaviors, physical activity habits)

  • Current medications (including complementary and alternative therapies) and medication taking behaviors (e.g., adherence, injection technique)

  • Past diabetes treatments, response to therapy, reason for discontinuation

  • Diabetes and nutritional education (currently enrolled and completed)

  • Self-monitorng of blood glucose (SMBG) results and self-management behaviors

  • Social and cultural Issues: preferences, values, and beliefs; health literacy

  • Physical exam: height, weight, BMI, blood pressure, heart rate, comprehensive foot exam

  • Labs (e.g. Glucose, A1C, Scr, BUN, eGFR, fasting lipid panel, urinary albumin/Cr ratio, serum electrolytes)


  • Diagnosis and classification (See Tables 74-1 and 74-3)

  • Microvascular and macrovascular complications and potential comorbid conditions

  • Achievement of A1C and glucose goals (see Table 74-6)

  • Appropriateness, effectiveness, safety/tolerability, treatment burden, cost and adherence of current antihyperglycemic regimen and additional treatment options being considered

  • Achievement of weight, lifestyle or other behavioral goals

  • Achievement of goals for comorbidities (e.g., blood pressure, lipids, neuropathic pain)

  • Screen for depression, anxiety, disordered eating

  • Screen for psychosocial problems and barriers to diabetes self-management


  • Set appropriate A1C and glucose goals based on age, comorbidities, and other factors (See Table 74-6)

  • Tailored lifestyle modifications (e.g., diet, exercise, weight management)

  • Drug therapy regimen including specific antihyperglycemic agent(s), dose, route, frequency, and duration; specify continuation and discontinuation of existing therapies (see Figure 74-4 and Tables 74-7, 74-10, and 74-11)

  • Monitoring parameters including efficacy (e.g., A1C, SMBG), safety (medication-specific adverse effects, hypoglycemia), and timeframe (see Tables 74-5 and 74-14)

  • Patient education (e.g., purpose of treatment, drug administration, dietary and lifestyle modification)

  • Referrals to other providers when appropriate (e.g., diabetes educator, registered dietician, eye care professional, podiatrist, mental health professional)


  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up including follow-up phone calls to adjust treatment

Follow-up: Monitor and Evaluate

  • Determine A1C and glucose goal attainment

  • Presence of adverse effects

  • Occurrence/development/progression of diabetes-related complications

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals


For the chapter in the Wells Handbook, please go to Chapter 19. Diabetes Mellitus.


Content Update

November 15, 2019

Semaglutide: The First Oral GLP-1 Receptor Agonist: In September 2019, the U.S. Food and Drug Administration (FDA) approved semaglutide (Rybelsus, Novo Nordisk) for treatment of type 2 diabetes mellitus (T2DM). The glucacon-like-peptide-1 (GLP-1) receptor agonists are a recommended second-line, add-on therapy to metformin for patients with T2DM who are at high-risk of ...

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