Diabetes

toc 1. Understand that improving morbidity and mortality in diabetics involves addressing multiple risk factors. (Hypertension, smoking cessation, and lipid control, as well as glucose control, daily aspirin and monitoring for depression) 2. Describe a stepwise approach for control of blood glucoses (as well as other risk factor reductions). 3. Apply effective lifestyle modifications and develop an initial action plan based on patient's goals for change. 4. Proficiently use the diabetes registry in PCIS with every diabetic patient to improve consistency of care
 * Objectives** (for resident training)

**Overviews**
American Diabetes Guidelines 7-page summary:

ADA-European Consensus Statement of management of hyperglycemia in Type 2 Diabetes: []

[|"Basic Guidelines for Diabetes Care]" from the [|California Diabetes Program] will likely soon become the accepted guidelines for CCRMC and health centers (12/2010), but for pregnancy, please refer to current OB department guidelines.

Contra Costa Health Services has 2008 [|guidelines] for diabetes care as well as a one-page [|summary] (but CCHS may also move to follow the guidelines of the California Diabetes Program)

Pittsburg Health Center Diabetes Referral Options

Diabetes-related training opportunities

**Treatment Aids**
Initiating Insulin per Patty Glatt by Oliver Graham (posted 1/2010) by Oliver Graham (posted 1/2010)
 * Diabetes Coalition of California Type 2 Diabetes Outpatient Insulin Guidelines[[file:DCC Insulin Guidelines 10.9.2010.pdf]]**

**Diebetes Management Clinic**
On March 1, 2014 the pharmacist based diabetes management clinic (DCM) will open up to referrals from all sites, initially limited to patients with A1C's >/=9.0. The goal is eventually to include all adult, non-pregnant diabetic patients. This will require the patient to make 1 face to face appt. with the pharmacist in Martinez, the rest of the care will be by telephone. The goal is to ultimately have some on site staffing of pharmacists in East and West county in the future for the face to face sessions with the pharmacist, given the transportation challenges many of our patients have. Instruction on insulin injection technique will still be done by local patient education nursing.

Diabetic Care Management (DCM) clinic is run by American Pharmaceutical Association (APhA) certified pharmacists in the Ambulatory Care setting. The certified pharmacists will be caring for “referred”, non-pregnant patients>20 years of age who have been diagnosed with Type 1 or Type 2 diabetes. The program uses a protocol-based algorithmic approach focusing on an optimal medication management in this vulnerable patient population. The program involves pharmacists adjusting oral diabetes medications and insulin, refilling medications, ordering labs, ordering referrals to ophthalmology, ordering vaccinations by protocol. For the first 21 patients enrolled in DCM, there was a statistically significant drop in mean A1C from 9.8 to 8.1 after less than 6 months enrollment! Over 75 Martinez patients are now enrolled in DCM.

To refer, order a "Diabetes Care Management - Internal Referral" in ccLink. As this program is much more comprehensive that the pilot treat to target (T2T) RN-run protocol started at West County Health Center, and includes adjustment of both long acting and short acting insulin, that pilot is being phased out. Already referred patients will continue to be managed until their target is reached or they fall of the protocol, but T2T is now closed to new referrals. To date, providers have expressed their satisfaction with the quality of the Diabetes Care Management service. They particularly appreciate the help concerning complicated cases with difficult to manage diabetes. Patients have expressed satisfaction with the service particularly if they are able to see the same pharmacist on their follow up visits. It is important to note that once the pharmacists are able to make the first visit with the patient, patient adherence rates are highly sustainable and reliable. Indian Health Service Treatment Guidelines: Excellent summary of how to achieve goals and treatment guidelines for diabetes and it's complications.

**Patient handouts**


[|Learningdiabetes.org] has lots of handouts in English and Spanish

**Supplies**
Mini Pharmacy. All glucometers here are covered. For CCHP, BHC, GO pts, you can only use True Track. - can fill these only at W/G (Rite-Aid also OK for HO only).
 * __Glucometers:__**- For Medical and Medicare patients, you generally need to use mail order (W/G will not fill). Here is fax order sheet for

Order free monofilaments (5 packs of 10) from [|www.hrsa.gov/leap]