T2DM Office-Visit Checklist
T2DM Office-Visit Checklist
T2DM Office-Visit Checklist
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DIAGNOSTIC CRITERIA<br />
Prediabetes<br />
*A1c 5.7% - 6.4%, or<br />
*FPG 100 mg/dL to 125 mg/dL, or<br />
*2-hr 75g OGTT 140 mg/dL -199 mg/dL<br />
Consider metformin, especially if BMI >35, 6.5%, or<br />
*FPG >126 mg/dL (minimum 8 hr fast), or<br />
*2-hr 75g OGTT >200 mg/dL, or<br />
Random plasma glucose >200 mg/dL with classic symptoms of<br />
hyperglycemia or hyperglycemic crisis<br />
*Test should be repeated to confirm. Preferably the same test; however if results of 2 different tests are above the threshold, the<br />
diagnosis is confirmed.<br />
GOALS<br />
At goal<br />
At goal<br />
At goal<br />
<strong>Checklist</strong> Item<br />
BP at goal of < 130/80 mm Hg<br />
LDL at goal of
LABS (con’t)<br />
Up to Date<br />
Due:<br />
Due:<br />
Due:<br />
Needs ordered<br />
Up to Date<br />
Needs ordered<br />
Indicated<br />
Needs ordered<br />
IMMUNIZATIONS<br />
Up to Date<br />
Due<br />
Up to Date<br />
Due<br />
Up to Date<br />
Due<br />
Not Indicated<br />
EXAMS/REFERRALS<br />
Up to Date<br />
Due:<br />
UAE with spot urine albumin-tocreatinine<br />
ratio<br />
Serum creatinine and calculated<br />
GFR<br />
Thyroid-stimulating hormone in<br />
type 1 diabetes, dyslipidemia, or<br />
women > age 50<br />
Annual Influenza<br />
Pneumococcal polysaccharide<br />
Age:<br />
Last administered:<br />
Hepatitis B<br />
Annual dilated and comprehensive<br />
eye exam<br />
Annually (confirmed by 2/3 abnormal within 3-6 months)<br />
Normal 300 µg/mg<br />
Annually<br />
Annually if indicated<br />
One time before age 64 plus one-time revaccination after age 64 if last<br />
vaccine was > 5 years prior<br />
Recommended in those < age 60. Over age 60 depending on need for<br />
assisted glucose monitoring, risk, and likelihood of immune response 3<br />
Less frequent (every 2-3 years) optional following >1 normal exams<br />
Due:<br />
Needs ordered<br />
Up to Date<br />
Annual comprehensive foot<br />
examination<br />
To include pedal pulses, and testing for loss of protective sensation (10-g<br />
mono-filament plus testing any one of the following: vibration using 128-<br />
Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception<br />
threshold)<br />
Needs ordered<br />
EDUCATION DISCUSSION POINTS<br />
Exercise<br />
At least 150 min/week of moderate-intensity aerobic physical activity (30 min / 5 days per week)<br />
Resistance training at least twice per week<br />
Hypoglycemia (BG < 70 mg/dL)<br />
Treatment: 15-20 g of glucose<br />
Glucagon for those at risk of severe events<br />
Smoking cessation<br />
Foot self-care<br />
Self-monitoring blood glucose<br />
Glucometer teaching & recommended frequency<br />
Nutrition<br />
All recommendations taken directly from the American Diabetes Association Standards of Medical Care in Diabetes- 2012, except as<br />
noted:<br />
1. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines.<br />
Circulation. 2004;110:227-239.<br />
2. FDA Expands Advice on Statin Risks. FDA's MedWatch Safety Alerts: February 2012. Available at:<br />
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm298416.htm#1. Accessed May 14, 2012.<br />
3. Centers for Disease Control and Prevention. Recommended adult immunization schedule—United States, 2012. MMWR 2012;61.<br />
Available at http://www.cdc.gov/vaccines/recs/schedules/default.htm. Accessed May 14, 2012.
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