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Step Status
Educational Materials
Release Date: Wed, 1/1/20
Termination Date: Thu, 12/31/20
Credits: 1
Description: Studies demonstrate that morbidity due to complications of diabetes can be reduced through prevention, detection, and management. This self-study provides practical guidance to clinicians about routine screening and prevention efforts for cardiovascular risk factors (hypertension, hyperlipidemia, tobacco use) and for microvascular disease (retinopathy, nephropathy, neuropathy. Management of glycemic control, risk factors, and complications is organized into specific care activities to be performed at each regular diabetes visit, every 3 to 6 months, and annually. Key recommendations for care are summarized at the beginning of the guideline. Participants in this self-study CME activity will gain a systematic overview of care for diabetes and be able to provide systematic care for diabetes and to help prevent or delay its complications.

New information in this revision:
  • Screening for diabetes. Although little evidence is available on screening for diabetes, screening should be considered every 3 years beginning at age 45 or annually at any age if BMI ≥ 25 kg/m2, history of hypertension, gestational diabetes, or other risk factors.
  • A1c for diagnosis. An option for diagnosing diabetes is hemaglobin A1c: 6.5% or greater is diagnostic, 5.7% -6.4% is considered pre-diabetes. (See Table 1 for diagnostic tests and values.)
  • New medications for glycemic control. Several new drugs (and drug cautions) have been released, particularly for second line therapy after metformin.
  • BP target. A reasonable clinical target is 135/80 mmHg. Mortality increases when patients with diabetes have a diastolic blood pressure below 70 mmHg. More aggressive control may be warranted in patients with renal disease. The HEDIS measure for BP in diabetes is <140/90 mmHg. The clinical target of 135/80 mmHg helps assure patients are under the measurement maximum and recognizes the potential clinical benefit of somewhat lower levels.
  • Prescribe "statin for all" patients with diabetes including those patients over > 40 years old with LDL < 100 mg/dl. Check baseline LFTS and if normal, no further monitoring is required. If baseline LFTs are mildly abnormal (over upper limit of normal but < 5 X upper limit of normal): monitor LFTs during first 6 months of statin treatment for stability. Abnormal baseline liver biochemistries can frequently improve with statin therapy.
  • Hepatitis B vaccination. Vaccinate patients with diabetes ages 19-59 years as soon as feasbile after diabetes is diagnosed. Risk is increased primarily due to sharing inadequately cleaned blood glucose monitors (e.g., in healthcare settings, households, worksite clinics, schools and camps). Consider vaccinating those aged ≥ 60 based on likelihood of acquiring HBV infection.
  • Measures of clinical care quality. National and regional third-party payors measure 13 aspects of care for patients with diabetes related to payment based on quality of care. See "Measures of Performance."
Educational Objectives: Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for the diagnosis and treatment of type 2 diabetes in adults.
Target Audience: This self-study activity is appropriate for primary care clinicians and other health care providers providing care for adults with type 2 diabetes.
Accreditation Information: The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Original Release Date: October 2012
Termination Date: June 2022

Continued availability of CME credit for this activity depends on a thorough review of its content every three years. This activity was last reviewed for currency and accuracy in June 2019, and availability of CME credit continued.
Additional Info: Authors:
Connie J Standiford, MD; General Internal Medicine
Sandeep Vijan, MD; General Internal Medicine
Hae Mi Choe, PharmD; College of Pharmacy
R Van Harrison, PhD; Medical Education
Caroline R Richardson, MD; Family Medicine
Jennifer A Wyckoff, MD; Metabolism, Endocrinology & Diabetes

Martha M Funnell, MS, RN, CDE; Diabetes Research and Training Center
William H Herman, MD; Metabolism, Endocrine & Diabetes

Financial Disclosure Information:
Martha M. Funnell, MS, RN, CDE
Advisory Boards; Boehringer Ingelheim, Bristol-Myers Squibb/ AstraZeneca, Halozyme Thera-peutics, Eli Lilly, Animas/ Lifescan, Hygeia Inc, Intuity Medical

William H. Herman, MD, MPH
Consultant: Cebix, Genentech, McKinsey & Co., Sanofi-Adventis, VeraLight

There are no other relevant financial relationships to disclose for this CME activity.

UMHS Guidelines Oversight Team:
Karl T. Rew, MD
R. Van Harrison, PhD

Literature Search Services:
Taubman Medical Library

Credits available:

AMA PRA Category 1: 1.00
Participation: 1.00