Diabetes Standards of Care and Resources for Clinicians and Educators
Recommendations At-a-Glance
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| Component | Care / Test / Screening | Frequency / Which Patients (“At diagnosis”=when diabetes is diagnosed) |
|---|---|---|
| General Recommendations for Care | Perform diabetes-focused visit | Every 3-6 months |
| Review care plan: assess goals/strengths/barriers | Each visit, revise as needed | |
| Assess nutrition, physical activity, BMI, and growth in youth | Each visit | |
| Aspirin or Other Antiplatelet Therapy | Aspirin therapy 75-162 mg/day (unless contraindicated, or at increased risk of bleeding) | Prescribe if known ASCVD Consider in patients aged 50-70 with no known ASCVD but with 1 or more risk factors for ASCVD |
| Autonomic Neuropathy | Assess CV symptoms; resting tachycardia, exercise intolerance, orthostatic hypotension | At diagnosis, then annually |
| Assess GI symptoms; gastroparesis, constipation, diarrhea | At diagnosis, then annually | |
| Assess sexual health/function for men and women | At diagnosis, then annually | |
| Behavioral Health | Assess emotional health (e.g., depression, substance abuse) | At diagnosis, then annually |
| Blood Pressure | Check blood pressure Adult and Adolescents aged ≥ 13 years goal: <130/<80 mmHg Children aged < 13 years goal: varies with age |
Each visit |
| DSME/S | Clinical provider and/or diabetes educator provides individualized DSME/S | At diagnosis, then annually or more as needed |
| Eye Care | Comprehensive dilated eye exam by an eye care professional or retinal imaging | At diagnosis, then annually or as directed by an eye care professional |
| Foot Care | Visual inspection of feet with shoes and socks off | Each visit; stress daily self-exam |
| Perform comprehensive lower extremity/foot exam | At diagnosis, then annually | |
| Screen for PAD (consider ABI) | At diagnosis, then annually | |
| Glycemic Control | Check A1C, set/review individualized goal | Every 3-6 months |
| Address medication adherence, hypoglycemia | Each visit | |
| Review BGM and/or CGM results, if prescribed | Each visit | |
| Hepatitis C Screening | Screen for hepatitis C with a hepatitis C antibody test | At least once for persons ≥ 18 years |
| Immunizations | Hepatitis B | Administer to unvaccinated adults aged 18 to 59; consider for unvaccinated adults ≥ 60 years based on infection risk |
| Influenza | Administer annually to everyone ≥ 6 months of age | |
| Pneumococcus | Administer pneumococcal conjugate vaccine (PCV20 or PCV15) to unvaccinated adults with diabetes aged 19 years of age and older. (If PCV15 is given, administer a dose of pneumococcal polysaccharide vaccine (PPSV23) ≥1 year later.) [See Immunization Standard of Care for recommendations for adults who have previously received any pneumococcal vaccine.] |
|
| Tetanus, diphtheria, and acellular pertussis (Tdap) or tetanus and diphtheria (Td) | Administer Tdap at least once to anyone who has not previously received Tdap. Provide booster Tdap or Td every 10 years | |
| Shingles (Herpes zoster) | Administer Shingrix two-dose vaccine to adults ≥ 50 years | |
| Kidney Care | Check quantitative UACR | At diagnosis, then at least annually |
| Check serum creatinine and estimated GFR | At diagnosis, then at least annually | |
| If HTN/CKD, prescribe ACE Inhibitor or ARB unless contraindicated | ||
| Lipid Management | Check fasting lipid profile | At diagnosis, then annually, as needed |
| Lifestyle therapy | All patients with diabetes | |
| Statin therapy | Patients with diabetes aged 40-75 years and those with ASCVD regardless of age | |
| Nutrition | Provide basic nutrition education (health care team) | At diagnosis, then annually, or more as needed |
| Refer to an RD for individualized MNT, when available | At diagnosis, then annually, or more as needed | |
| Oral Care | Inspection of gums/teeth | At diagnosis, then at least annually |
| Dental exam by dental professional | At diagnosis, then at least annually | |
| Preconception, Pregnancy, and Postpartum Care | Ask about reproductive intentions/assess contraception | At diagnosis, then each visit |
| Provide preconception counseling | 3-4 months prior to conception | |
| Screen for undiagnosed type 2 diabetes | At first prenatal visit | |
| Screen for GDM in all women not known to have diabetes | At 24-28 weeks gestation | |
| Screen for type 2 diabetes in women who had GDM | At 6-12 weeks postpartum, then every 1-3 years lifelong | |
| Tobacco Use | Assess smoking, oral tobacco use, e-cigarette use, and exposure to secondhand smoke | Screen annually |
| For tobacco users, provide cessation counseling | Each visit | |
| Tuberculosis Screening | Screen for TB with a skin or blood test | At least once after diabetes diagnosis |
