Selecting a Treatment Regimen
ÎEvery patient with documented DM requires a comprehensive treatment program, taking into account the patient's unique medical history, behaviors and risk factors, ethnocultural background, and environment (A-4).
ÎAn 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.
ÎThe 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
ÎPersons 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
Treatment Goal
Glucose HbA1c, %
Individualize on the basis of age, comorbidities, duration of disease; in general, ≤ 6.5 for most; closer to normal for healthy; less stringent for "less healthy"
FPG, mg/dL
2-Hour postprandial glucose (PPG), mg/dL
Inpatient hyperglycemia: glucose, mg/dL
Lipids
Low-density lipoprotein cholesterol (LDL-C), mg/dL
Non–HDL-C, mg/dL Triglycerides, mg/dL 4
Blood pressure Systolic, mmHg Diastolic, mmHg
≤ 70 highest risk; < 100 high risk
Apolipoprotein B, mg/dL < 80 highest risk; < 90 high risk HDL-C, mg/dL
< 150 < 130
< 80
< 100 highest risk; < 130 high risk > 40 in men; > 50 in women
D-4 B-1/2
< 110 < 140
140-180 D-4 D-4 Evidence Grade
