insurance coverage; and individual needs such as display size, auditory function, and meter size. 3. Joan would likely benefit from diabetes self-management education and support (DSMES). This need should be assessed and provided annually as appropriate. Joan’s health care provider may suggest a change in her medications and encourage BGM until glycemic goals
are achieved. It is important to tell Joan that if she is on Medicare, they will only pay for enough strips for one day of checking. Other insurance companies may vary unless the person with diabetes is on insulin three times/daily. Joan must bring her meter or logbook to every visit with her health care provider so they can go over the results and assist with clinical decision making.
ADDITIONAL MONITORING
The goals for the treatment of diabetes are purposeful to prevent or delay potential complications, which optimize the patient’s quality of life. With that goal in mind, it is vital to understand that blood glucose levels only tell part of the story. Because diabe- tes is a leading risk factor for cardiovascular disease, stroke, and renal failure, it is essential to monitor and control the factors as- sociated with these vascular complications. Blood pressure, lipid Hypertension Hypertension is defined as a blood pressure (BP) sustained at or above 140/90 mmHg and is commonly associated with type 1 and type 2 diabetes 24 . Treatment recommendations for patients with diabetes and hypertension should be individualized with acknowl- edgment of patient preferences, cardiovascular risk assessment, potential adverse effects, significant drug-drug, drug-disease, or drug-food interactions, and accessibility of antihypertensive med- ications. Recommendations for individuals with diabetes and high Dyslipidemi Because dyslipidemia is common in patients with diabetes, lipid levels should be screened 24 . A lipid panel includes the total cho- lesterol, low- density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride levels. Hypertriglyceridemia, high LDL cholesterol (especially the small, dense LDL particles), and low levels of HDL cholesterol commonly coexist with diabetes. For patients under the age of 40, it is recommended to obtain a lipid End-stage renal failure End-stage renal failure is a common microvascular complication of diabetes. In fact, diabetic nephropathy is known as the leading cause of end- stage renal disease in the United States 24 . Screening for kidney disease involves urine testing for albumin levels. Albu- min is a plasma protein particle that is typically too large to be eliminated by healthy kidneys. In diabetic nephropathy, renal tu- bules are damaged, and albumin begins to escape into the urine. The earliest sign of nephropathy is the appearance of persistent microalbuminuria. When measured directly, a microalbumin level of less than 30 mg per day is considered normal. A level between 30 and 299 mg per day is defined as microalbuminuria, and levels greater than 300 mg per day signify clinical albuminuria and incip- ient renal failure. Spot collections of urine to measure the micro- albumin to creatinine ratio are generally recommended. Patients with type 1 diabetes are screened annually after the 5th year of a Conclusion BGM, either with fingersticks and a glucometer or a continuous glucose monitor is an essential part of diabetes management plans. However, BGM alone does not improve diabetes out- comes. Patients must integrate results into their self-management plans to observe changes in blood glucose levels. A1C monitor- ing every 3 to 6 months for all persons with diabetes and a TIR for those using a CGM enables the health care provider to demon- strate to people how their self-monitoring at home correlates with the office monitoring of glucose management and is associated
profile, and urine albumin levels should be measured at every routine clinical visit to alert the clinician to potential complications related to diabetes. For more information on the monitoring and treatment of the following conditions, please review the American Diabetes Associations Standards of Medical Care in Diabetes, re- leased in January of 2022. cardiovascular risk should have a BP target of <130/80 mmHg if this BP can be safely attained; an individual with diabetes and a lower cardiovascular risk would benefit from a BP <140/90 mmHg. The patient’s blood pressure should be measured at every outpa- tient visit and treated aggressively to achieve and maintain tar- get pressure levels. All hypertensive patients would benefit from home blood pressure monitoring. profile at the time of diagnosis, at the initial medical evaluation, and then every 5 years thereafter, unless there is a need for more frequent monitoring. If the patient is on medication for dyslipid- emia, the recommendation is to obtain a lipid profile at the initia - tion of the medication, 4 to 12 weeks after initiation or a change in dose, and then annually monitor the response to therapy. diabetic diagnosis and during pregnancy, regardless of the dura- tion of diabetes. Patients with type 2 diabetes are screened at diagnosis for microalbuminuria and annually thereafter. Self-Assessment Quiz Question #5 What is the primary purpose for treatment guidelines set in the management of diabetes for both type 1 and type 2? a. To ensure the blood glucose levels are maintained as close to optimal as possible. b. To prevent or delay potential complications caused by diabetes. c. To prevent diabetes from being passed from generation to generation. d. To educate the patient with diabetes on healthy living. with the prevention of complications that occur with prolonged hyperglycemia. With advances in diabetes technology, CGM has moved beyond BGM by providing real-time data with an ability to detect glycemic trends, rate of change information, and gly- cemic variability in a range of time, all of which support efforts to minimize the complications associated with hypoglycemia and hyperglycemia.
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