Clinical Initiatives
Diabetes
Definitions Categorizing Types of Diabetes
To include associated co-morbid illnesses
| Diabetes mellitus Type I | To have fasting blood sugar > 126; 2 hr blood sugar > 200; or random blood sugar > 200 with symptoms. | Autoimmune mediated, insulin deficient, ketosis prone, insulin therapy required initially or early in treatment. Generally less than 40 years old. |
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| Diabetes mellitus Type II | Insulin resistant, generally obese, and greater than 40 years old. Initially hyperinsulinemia, then insulin deficient over time. | |
| Prediabetes | Abnormal fasting glucose (fasting sugars 100-126 or abnormal glucose tolerance, (two-hour blood sugar 140-200) | |
| Hypertension (HTN) | Blood pressure greater that 140/90. | |
| Hyperlipidemia | Total cholesterol greater than 200. Triglycerides greater than 150. HDL cholesterol less than 40. LDL cholesterol greater than 130. |
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| Nephropathy | Microalbuminuria or greater protein loss or documented renal insufficiency. (Microalbuminuria = > 30 mg per 24 hours on two separate occasions in a six-month interval.) |
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| Neuropathy | Peripheral neuropathy, with hypo- or hyperesthesia, abnormal monofilament testing. Autonomic neuropathy, with documented abnormal gastric emptying, postural hypotension or impotence. |
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| Retinopathy | Presence of microaneurysms or further progression noted. (Would not include cataracts alone.) |
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| Coronary Heart Disease (CHD) | Acute MI Coronary Artery Disease Ischemic Heart Disease |
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| Cerebrovascular Disease | Carotid Disease Stroke / TIA |
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| Other BP Med | BP medication other than ACE or ARB. |
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DM Education |
Completed the nova DM curriculum with NP/PA or ADEF program at any point in the medical history. |
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| SM Goal | A goal has been established, after review of a completed Self-Management Support Tool, a copy of which is given to the patient and a copy is retained in the chart. |
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| Retinal Ex | A copy of the annual eye exam report in the chart. |
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Foot chk |
An annual monofilament test documented in the chart. |
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Smk Assmt |
Yes, no or former documented annually. |
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Smk Ce Counseling |
For "yes" above, counseling documented annually. |
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Flu Vac |
Annually |
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Pne Vac |
All DM patients with no previous vaccine are to be vaccinated. If current age > 65 years and was > 65 years at time of last vaccination, revaccination NOT indicated. If current age > 65 years and was < 65 years at time of last vaccination and > 5 years have elapsed since first dose, revaccination IS indicated. NOTE: For any person who has received a dose of pneumococcal vaccine at age > 65 years, revaccination is not indicated. |
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Revised: 4/10/06