Comprehensive Diabetes Management

Initial Evaluation and Assessment

A complete medical evaluation should be performed at diagnosis to classify diabetes, detect complications, review previous treatment, and establish a management plan, as recommended by the American Diabetes Association 1, 2
Laboratory tests should include HbA1c, fasting glucose, lipid profile, kidney function tests, and urine albumin-to-creatinine ratio, according to the American Diabetes Association 1
Screen for autoimmune conditions in type 1 diabetes, such as thyroid dysfunction and celiac disease, as suggested by the American Diabetes Association 2
Assess for comorbidities including obesity, hypertension, dyslipidemia, and existing microvascular complications, as recommended by the American Diabetes Association 1

Diabetes care should be managed by a multidisciplinary team including physicians, nurse practitioners, nurses, dietitians, pharmacists, and mental health professionals, as recommended by the American Diabetes Association 1, 3
The management plan should be written with input from the patient, family, physician, and other healthcare team members, according to the American Diabetes Association 1, 2
Implement shared decision-making to improve treatment adherence, patient satisfaction, and clinical outcomes, as suggested by the American College of Physicians 4

Set individualized HbA1c targets based on patient's age, comorbidities, risk of hypoglycemia, and life expectancy, as recommended by the American Diabetes Association 1
Regular HbA1c testing (typically every 3-6 months) is recommended to assess long-term glycemic control, according to the American Diabetes Association 1
The proportion of people with diabetes who achieve recommended A1C, blood pressure, and LDL cholesterol levels has fluctuated over the years, with only 23% meeting all three targets while avoiding smoking, as reported by the American Diabetes Association 3

Implement medical nutrition therapy with individualized meal planning, as recommended by the American Diabetes Association 1, 5
No ideal percentage of calories from carbohydrate, protein, and fat exists for all people with diabetes; macronutrient distribution should be based on individualized assessment, according to the American Diabetes Association 5
Various eating patterns can be effective, including Mediterranean-style, DASH, plant-based, lower-fat, and lower-carbohydrate patterns, as suggested by the American Diabetes Association 5

Encourage 30-60 minutes of moderate aerobic activity daily, at least 5 days per week, as recommended by the American Heart Association 6
Consider adding resistance training twice weekly, according to the American Heart Association 6

For overweight/obese patients, prescribe high-intensity diet, physical activity, and behavioral therapy designed to achieve ≥5% weight loss, as recommended by the American Diabetes Association 1
Recommend 500-750 kcal/day energy deficit to promote weight loss, according to the American Diabetes Association 1

Provide DSMES to all patients at diagnosis and at critical points throughout their care, as recommended by the American Diabetes Association 7
Education should focus on helping patients make informed self-management choices rather than simply providing information, according to the American Diabetes Association 7
Include essential content on hypoglycemia/hyperglycemia recognition and treatment, medication administration, blood glucose monitoring, and nutritional management, as suggested by the American Diabetes Association 7

Initiate pharmacologic therapy at diagnosis of type 2 diabetes, in addition to lifestyle therapy, as recommended by the American Diabetes Association 1
For metabolically stable patients, metformin is the initial treatment of choice if renal function is adequate, according to the American Diabetes Association 1

Blood pressure control is recommended (target <140/90 mmHg or <130/80 mmHg for individuals with chronic kidney disease or diabetes), as suggested by the American Heart Association 6
Initiate blood pressure medication as tolerated, treating initially with beta blockers and/or ACE inhibitors, according to the American Heart Association 6
Manage lipid abnormalities aggressively, particularly in patients with cardiovascular disease, as recommended by the American Heart Association 6

Conduct regular screening for microvascular complications, including annual comprehensive eye examination, screening for diabetic kidney disease, and comprehensive foot examination, as recommended by the American Diabetes Association 1
Screen for and treat modifiable cardiovascular risk factors, according to the American Diabetes Association 1
Provide all age-appropriate vaccinations, as suggested by the American Diabetes Association 1