Selecting a Treatment Regimen
ÎEvery patient with documented DM requires a comprehensive treatment
Î
program, taking into account the patient's unique medical history, behaviors
and risk factors, ethnocultural background, and environment (A-4).
ÎÎAn organized multidisciplinary team may best deliver care for
patients with DM. Members of such a team can include a primary care
physician, endocrinologist, physician assistant, nurse practitioner,
registered nurse, certified diabetes educator (CDE), dietitian, exercise
specialist, and mental health care professional.
ÎÎThe educational, social, and logistical elements of therapy and the
variation in successful care delivery associated with age and maturation
present additional complexity when caring for children with DM (D-4).
Self-Management Education
ÎÎPersons with DM should receive comprehensive DM self-management
education at the time of DM diagnosis and subsequently as appropriate.
Note: Therapeutic lifestyle management must be discussed with all patients with DM and
prediabetes at the time of diagnosis and throughout their lifetime. This includes medical
nutrition therapy (with reduction and modification of caloric and fat intake to achieve
weight loss in those who are overweight or obese), appropriately prescribed physical activity,
avoidance of tobacco products, and adequate quantity and quality of sleep (D-4).
Table 3. Comprehensive Diabetes Care Treatment Goals
Parameter
Glucose
HbA1c, %
FPG, mg/dL
2-Hour postprandial
glucose (PPG), mg/dL
4
Inpatient hyperglycemia:
glucose, mg/dL
Lipids
Low-density lipoprotein
cholesterol (LDL-C),
mg/dL
Non–HDL-C, mg/dL
Apolipoprotein B, mg/dL
HDL-C, mg/dL
Triglycerides, mg/dL
Blood pressure
Systolic, mmHg
Diastolic, mmHg
Treatment Goal
Evidence Grade
Individualize on the basis of age,
D-4
comorbidities, duration of disease;
in general, ≤ 6.5 for most; closer to
normal for healthy; less stringent for
"less healthy"
< 110
< 140
140-180
D-4
≤ 70 highest risk; < 100 high risk
B-1/2
< 100 highest risk; < 130 high risk
< 80 highest risk; < 90 high risk
> 40 in men; > 50 in women
< 150
< 130
< 80
D-4
