Diabetes Assessment/Plan

Assessment & Plan Elements, Endocrine, Nutrition & Obesity
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A1c:
-at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control).
-quarterly in patients whose therapy has changed or who are not meeting glycemic goals
-for microvascular disease prevention and macrovascular risk reduction, the A1C goal for nonpregnant adults in general is less than 7%
-less stringent A1C goals (such as less than 8%) if
-- a history of severe hypoglycemia
-- limited life expectancy
-- advanced microvascular or macrovascular complications
-- extensive comorbid conditions

Self-Management:
-appropriate glucose monitoring to meet specific goals (such as fasting blood sugar less than 130 mg/dL)
-medication adherence and self-adjustment as needed

Lifestyle:
-moderate weight loss (7% body weight) and regular physical activity (150 min/week) can reduce the risk of diabetes complications and improve glycemic control.
-the U.S. Department of Agriculture (USDA) recommendation for dietary fiber is 14 g fiber/1,000 kcal
-increase foods containing whole grains (one-half of grain intake).
-saturated fat intake should be reduced
-reduce intake of trans fat (lowers LDL cholesterol and increases HDL cholesterol)
-monitor carbohydrate, whether by carbohydrate counting, exchanges, or experience-based estimation
-perform at least 150 min/week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate).
-in the absence of contraindications, perform resistance training three times per week.
A1c:
-at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control).
-quarterly in patients whose therapy has changed or who are not meeting glycemic goals
-for microvascular disease prevention and macrovascular risk reduction, the A1C goal for nonpregnant adults in general is less than 7%
-less stringent A1C goals (such as less than 8%) if
-- a history of severe hypoglycemia
-- limited life expectancy
-- advanced microvascular or macrovascular complications
-- extensive comorbid conditions

Self-Management:
-appropriate glucose monitoring to meet specific goals (such as fasting blood sugar less than 130 mg/dL)
-medication adherence and self-adjustment as needed

Lifestyle:
-moderate weight loss (7% body weight) and regular physical activity (150 min/week) can reduce the risk of diabetes complications and improve glycemic control.
-the U.S. Department of Agriculture (USDA) recommendation for dietary fiber is 14 g fiber/1,000 kcal
-increase foods containing whole grains (one-half of grain intake).
-saturated fat intake should be reduced
-reduce intake of trans fat (lowers LDL cholesterol and increases HDL cholesterol)
-monitor carbohydrate, whether by carbohydrate counting, exchanges, or experience-based estimation
-perform at least 150 min/week of moderate-intensity aerobic physical activity (50–70% of maximum heart rate).
-in the absence of contraindications, perform resistance training three times per week.
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