HealthTeamWorks has revised its clinical diabetes guideline to give providers a new screening algorithm, updated medication information and new tools for patients. Users familiar with the previous version, released in 2006, will first notice the new title: Guideline for Type 2 Diabetes. We make the distinction between Type 1 diabetes, which usually requires care by an endocrinologist, and Type 2, which usually falls under the purview of primary care.
The revised guideline features:
A message noting that type 2 diabetes can be prevented or delayed by a healthy diet, an active lifestyle and a healthy body weight;
A new algorithm to screen for type 2 diabetes;
A recommendation to assess medication adherence, glucose control/hypoglycemia, and alcohol and drug use;
A new glucose management algorithm;
A flow sheet indicating what needs to be done for the patient at every visit, quarterly and annually;
A patient handout and action plan; and
A medication chart.
“The new guideline allows the clinician to determine, ‘How much do I need to get the HgA1c* down, and what’s going to be the best [therapeutic] agent?’” says Stephanie Bacon, MS, RD, PA-C. She and Rocio Pereira, MD, chaired the guideline revision committee. Other members included two public health officials, seven physicians, two midlevel providers, a doctor of pharmacy, an optometrist and HealthTeamWorks Guidelines staff. The committee revised the guideline using evidence from the American Diabetes Association, the U.S. Preventive Services Taskforce and the American College of Endocrinology. Funding came from The Colorado Health Foundation.
Diabetes affects 8.3 percent of Americans — nearly 26 million people.1 Almost 19 million new cases are diagnosed each year, but another 7 million go undiagnosed.2 Diabetes is the leading reason for kidney failure, nontraumatic lower-limb amputations and new cases of blindness among adults, as well as a major cause of heart disease and stroke. It’s the seventh leading cause of death in this country.
In adults, type 2 diabetes accounts for about 90 percent to 95 percent of all diagnosed cases. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity and ethnicity. African Americans, Hispanics, American Indians, and some Asian Americans and Pacific Islanders are at particularly high risk for type 2 diabetes and its complications.3
The incidence of type 2 diabetes mirrors the incidence of obesity among Americans. From 1980-2009, the number of Americans with diabetes has more than tripled, from 5.6 million to 19.7 million.4 If the trend is not reversed, one in three Americans will have diabetes by 2050.5
“Preventing a patient from becoming diabetic is much better than treating it after the fact,” Bacon says. “If you can decrease HgA1c by 1 percent, you reduce the risk of [diabetic] complications by 40 percent.”
HealthTeamWorks is mailing laminated copies of the revised diabetes guideline to 5,210 clinicians across Colorado. It’s also available for free download on our website. If you have questions about the guideline, please contact Emily Gingerich.
*Hemoglobin A1c is a lab test that shows the average amount of sugar in the blood over three months — an indicator of diabetes control.
1. National Diabetes Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. 2011. www.diabetes.niddk.nih.gov/dm/pubs/statistics/#fast
3. Centers for Disease Control and Prevention. 2011 National Diabetes Fact Sheet. www.cdc.gov/diabetes/pubs/general11.htm
4. Centers for Disease Control and Prevention. Diabetes Data and Trends. www.cdc.gov/diabetes/statistics/prev/national/figpersons.htm
5. American Diabetes Association. Diabetes basics. www.diabetes.org/diabetes-basics/