Diabetes

Overview

Chronic metabolic disease characterized by hyperglycemia due to impaired insulin secretion, insulin action, or both (type 1 and type 2 diabetes)

• Associated with increased risk of
  
  • Cardiovascular disease
  • Stroke
  • Chronic kidney disease
  • Neuropathy
  • Vision loss
  • Mortality

Prediabetes

• Blood glucose levels above normal but below the diagnostic threshold for diabetes
• Without intervention, prediabetes can progress to type 2 diabetes
• Early identification and intensive lifestyle intervention can prevent or delay progression

_{Source: See Diabetes Resources (References 1-6, 27)}

Implement standardized diabetes care pathways that promote routine monitoring, individualized treatment, and progression prevention

• Risk assessment
• Prediabetes indentification
• Screening recommendations
• Diagnostic criteria
• Routine monitoring (A1c, BP, lipids, kidney health, etc.)

Prediabetes

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Prediabetes Identification

1. Screen patients at risk: ADA Type 2 Diabetes Risk Test
2. Educate on evidence-based lifestyle changes (nutrition, physical activity, weight management)
3. Refer to a CDC-recognized National Diabetes Prevention Program:
   
   • Medicare Diabetes Prevention Program (Medicare DPP)
   • ADA Diabetes Prevention Program For People at Risk

Standardized Diabetes Care and Monitoring:
2026 ADA Standards of Care Diabetes Medical Evaluation

Why is this important?

• Use standardized workflows and reminders to ensure consistent monitoring (A1C, CGM, foot exams, kidney health, and retinal screening)
• Individualize glycemic goals while routinely assessing blood pressure, lipids, kidney disease, and cardiovascular risk
• Screen for SDOH (food insecurity, medication cost, transportation, health literacy) that affect diabetes outcomes
• Leverage registries, telehealth,and care gap tools to improve follow-up and population health management

Health Resources and Services Administration Workflow for Diabetes Telehealth

• Use structured telehealth workflows for scheduling, data review, and follow-up
• Implement pre/post-visit protocols + remote communication to support continuous monitoring

Diagnostic Criteria

ADA Diabetes Health Check Points

• A1C
  
  • Average goal is less than 7
  • Every 3-6 months
• Albumin to creatinine ratio
  
  • <30 mg/g of urine creatinine
  • annually
• Ankle brachial index
  
  • Ankle BP compared to arm
  • Target is 0.9-1.3
  • If symptomatic for peripheral artery disease
• Blood pressure
  
  • Less than 130/80 mmHg
  • Every visit with a provider
• Bone mineral density
  
  • T-score at or above –1
  • Baseline scan when women begin menopause and men at age 50
• Body Mass Index
  
  • 18.5 to 24.9
  • Checked every visit
• Dialated Eye Exam
  
  • T1D– within 5 year of diagnosis and then annually
  • T2D– at diagnosis and then annually
• Estimated Glomerular Filtration Rate
  
  • Higher than 80 ml/min/1.73 m²
  • Annually
• Cholesterol and triglycerides
  
  • Every 5 years, more frequent with new medication monitoring

Continuous Glucose Monitoring

_{Source: See Diabetes Resources (References 11-17, 20, 22, 24, 28, 29)}

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Implement evidence-based strategies to support sustainable health improvements

• Screen early for prediabetes/diabetes and promote nutrition, physical activity, weight management, and reduced alcohol use to prevent progression
• Optimize glycemic control and manage comorbidities (CVD, CKD) through ongoing monitoring and risk reduction strategies

Type 2 Diabetes Treatment

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Pharmacologic Approaches to Obesity Treatment in Individuals with Diabetes

Lifestyle Change and Behavior Support:

1. Follow a healthy dietary pattern at every stage of life
2. Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations
3. Focus on meeting food groups needs with nutrient-dense foods and beverages, and stay within daily calorie needs
4. Limit alcoholic beverages and foods or beverages higher in added sugars, saturated fat, and sodium

Diabetes Distress Screening

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Problem Areas In Diabetes (PAID)-5 screening tool

Patient Education Materials

• Low Carb Diet for Type 2 Diabetes
• Weekly Exercise Targets
• Diabetes and Cognitive Behavioral Therapy

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Complication Prevention Resources:

• Detecting Diabetic Retinopathy
• CDC Hypoglycemia Prevention & Response
• 15-15 Rule for Hypoglycemia
• Insulin Initiation Safety Checklist

Glucagon Administration Guide

_{Source: See Diabetes Resources (References 10-12, 19, 22, 27,29-31)}

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Addressing Barriers to Diabetes Care

SDOH in Diabetes

• Key barriers to screen for: Food insecurity, medication cost, transportation, and low health literacy
• Clinical impact: SDOH directly affect A1c, adherence, complication risk, and follow-up care
• Action: After screening, connect to resources → tailor treatment plan to patient context

_{Source: See Diabetes Resources (Reference 23)}

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