Management of Type 2 Diabetes Mellitus

UMHS Type 2 Diabetes Guideline Update, December 2009. University of Michigan. Guidelines for. Health System. Clinical Care. Diabetes Mellitus. Guideline …

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Management of Type 2 Diabetes Mellitus
University of Michigan
Health System

Guidelines for
Clinical Care

Management of Type 2 Diabetes Mellitus
Diabetes Mellitus
Guideline Team
Team Leader
Sandeep Vijan, MD
General Internal Medicine

Team Members
Hae Mi Choe, PharmD
College of Pharmacy
Martha M Funnell, MS,
Diabetes Research and
Training Center
Steven J Bernstein, MD
General Internal Medicine
R Van Harrison, PhD
Medical Education
William H Herman, MD
Endocrinology and
Denise Campbell-Scherer,
Family Medicine
Robert W Lash, MD
Endocrinology and

December 2009
UMHS Guidelines
Oversight Team
William E. Chavey, MD
Connie J. Standiford, MD
R. Van Harrison, PhD
Literature search service
Taubman Medical Library
For more information call
GUIDES: 734- 936-9771
(c)Regents of the
University of Michigan
These guidelines should not be
construed as including all
proper methods of care or
excluding other acceptable
methods of care reasonably
directed to obtaining the same
results. The ultimate judgment
regarding any specific clinical
procedure or treatment
must be made by the physician
in light of the circumstances
presented by the patient.

Patient population. Adult
Objectives. Improve adherence to important, morbidity-reducing recommendations for preventing,
detecting, and managing diabetic complications.

Key points
Screening. Although little evidence is available on screening for diabetes, one may consider beginning
screening at age 45 at 3-year intervals, earlier particularly if BMI  25 kg/m2 [evidence: D].
Prevention. In individuals at risk for diabetes (see Table 1), diet, exercise, and pharmacologic
interventions can delay or prevent type 2 diabetes [A].
Diagnosis. Either two separate fasting glucoses  126 mg/dL, or if symptoms, a glucose  200 mg/dL
confirmed on a separate day by a fasting glucose  126 mg/dL, or 2-hour postload glucose  200 mg/dl
during an oral glucose tolerance test [B]. (See Table 1.) HbA1c has low sensitivity, but high specificity,
for the diagnosis of diabetes, and most experts feel that is should not be used as a primary diagnostic
Treatment. Diet, exercise, and pharmacologic interventions should be initiated for:
* Hypertension control [A]
* Glycemic control [A]
* Lipid control [A]
* Cardiovascular risk reduction [A]
Ongoing screening and management. Routine screening and prevention efforts for cardiovascular risk
factors (hypertension, hyperlipidemia, tobacco use) and for microvascular disease (retinopathy,
nephropathy, neuropathy) are recommended to be performed in the following time frames. Management
of risk factors, complications, and glycemia is summarized in the referenced tables.
Each regular diabetes visit

Every 3 to 6 months

* Diabetes visit every 3 months for
patients on insulin; every 6
months for patients on oral agents
or diet only [D].
* Blood pressure measured and
controlled [A]. (See Table 2)
* Weight checked [D].
* Inspect feet each visit if presence
of neuropathy; otherwise annually
[A]. (See Tables 2 and 8)
* Smoking cessation counseling
provided for patients with tobacco
dependence [B]. (See Table 2)
* Very important self-management
goals reviewed and reinforced.
(See Table 8) [A]

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