What I've written in this post, better expressed and much much more extensive you can find it in https://care.diabetesjournals.org/content/43/Supplement_1/S37
- The ADA recommends the physician should adapt his/her language to patients' characteristics, evaluate cultural barriers to communication, and have into account their preferences and beliefs. Common sense.
- Diabetes care should be provided by a multidisciplinary team including primary care physicians, subspecialty physicians, nurse practitioners, physician assistants, nurses, dietitians, exercise specialists, pharmacists, dentists, podiatrists, and mental health professionals. ADA must be talking about the ideal world...
- Confirm diagnosis of diabetes and classificate.
- Evaluate comorbidities and diabetic complications.
- If already known diabetes, record previous treatments and risk factor management.
- Involve the patient in a care management plan.
- Develop a care plan.
So you see there are 49 items for an initial visit and 43 for an annual visit, some of them may take quite a lot of time!! So, how many diabetic patients can you see in one morning if you want to do your job well?
TREATMENT PLAN. It must include:
Every aspect of this plan will be extensively reviewed later in its corresponding chapter.
Factors that increase hypoglycemia risk are:
- Insulin or secretagogue treatment
- Chronic kidney or hepatic disease
- Long-term diabetes
- frailty and older age
- Hypo unawarenesss or impaired contraregulatory response
- Cognitive impairment or physical disability
- Alcohol use
- Polypharmacy
Referrals for initial care management include:
- Annual dilated eye exam
- Family planning for women of reproductive age
- Registered dietitian nutritionist for nutrition therapy
- Diabetes Self-Management Education and Support
- Dentist
- Mental health professional if indicated.
Well, this post is getting too long, I'll leave the rest of the chapter for a second one that includes immunizations and assessment of comorbidities (autoimmune diseases, cancer, cognitive impairment, NEFA, hepatitis C, pancreatitis, fractures, HIV, male hypogonadism, obstructuve sleep apnea, periodontal disease).
