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PATIENT CARE PROCESS

Patient Care Process for the Management of Diabetes

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Collect

  • 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)

Assess

  • 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

Plan*

  • 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)

Implement*

  • 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

CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK

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

CONTENT UPDATE

Content Update

May 17, 2019

Pharmacotherapy Recommendations for Patients with Diabetes Mellitus and Cardiovascular or Chronic Kidney Disease: The 2019 guideline update for management of diabetes mellitus strengthened the recommendations for specific agents in the setting of coexisting chronic disease states such as atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), and chronic kidney disease (CKD). These recommendations incorporate recently published ...

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